Vigo Valentina, Lisi Piero, Galgano Giuseppe, Lomonte Carlo
1 Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti (BA) - Italy.
2 Division of Cardiology and Coronary Intensive Care Unit, Miulli General Hospital, Acquaviva delle Fonti (BA) - Italy.
J Vasc Access. 2018 Jan;19(1):92-93. doi: 10.5301/jva.5000760.
Valvular disease and pulmonary hypertension are common conditions in haemodialysis patients. In presence of tricuspid regurgitation, an increased retrograde blood flow into the right atrium during ventricle systole results in a typical modification of the normal venous waveform, creating a giant c-v wave. This condition clinically appears as a venous palpable pulsation within the internal jugular vein, also known as Lancisi's sign.
An 83-year-old woman underwent haemodialysis for 9 years. After arteriovenous fistula thrombosis, a right internal jugular vein non-tunnelled central venous catheter (CVC) was placed. About one month later, the patient was referred to our facility for the placement of a tunnelled CVC. Neck examination revealed an elevated jugular venous pulse, the Lancisi's sign. Surprisingly, chest x-ray posteroanterior view showed the non-tunnelled catheter tip in correspondence with the right ventricle. She underwent surgery for temporary to tunnelled CVC conversion using the same venous insertion site (Bellcath®10Fr-length 25 cm to Mahurkar®13.5Fr-length 19 cm). In the postoperative period, we observed a significant reduction of the jugular venous pulse.
The inappropriate placement of a 25-cm temporary CVC in the right internal jugular vein worsened the tricuspid valve regurgitation, which became evident by the Lancisi's sign. Removal of the temporary CVC from the right ventricle resulted in improved right cardiac function. Safe approaches recommended by guidelines for the CVC insertion technique and for checking the tip position should be applied in order to avoid complications.
瓣膜疾病和肺动脉高压是血液透析患者的常见病症。存在三尖瓣反流时，心室收缩期右心房内逆行血流增加会导致正常静脉波形发生典型改变，形成巨大的c-v波。这种情况在临床上表现为颈内静脉内可触及的静脉搏动，也称为兰奇西征。
一名83岁女性接受血液透析9年。动静脉内瘘血栓形成后，置入了一根右侧颈内静脉非隧道式中心静脉导管（CVC）。大约一个月后，患者因置入隧道式CVC被转诊至我院。颈部检查发现颈静脉搏动升高，即兰奇西征。令人惊讶的是，胸部后前位X线片显示非隧道式导管尖端与右心室相对应。她接受了手术，在相同静脉插入部位将临时CVC转换为隧道式CVC（从Bellcath®10Fr-长度25 cm转换为Mahurkar®13.5Fr-长度19 cm）。术后，我们观察到颈静脉搏动明显减轻。
右侧颈内静脉置入25 cm的临时CVC位置不当，使三尖瓣反流恶化，通过兰奇西征得以显现。将临时CVC从右心室取出后，右心功能得到改善。应采用指南推荐的CVC插入技术和检查尖端位置的安全方法，以避免并发症。
