Fabiani Adam, Dreas Lorella, Sanson Gianfranco
1 Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy.
2 School of Nursing, University of Trieste, Trieste, Italy.
J Vasc Access. 2018 Nov;19(6):667-671. doi: 10.1177/1129729818769032. Epub 2018 Apr 12.
: A safe, largely used practice for difficult venous access patients is positioning a catheter in deeper veins under ultrasound guide. However, the risk of complications is increased when there is a high catheter-to-vein ratio or when the insertion site is in a zone with particular anatomical/physiological characteristics.
: A 60-year-old woman admitted to a post-operative intensive care unit after cardiac surgery had a complicated post-operative course. After the removal of a central venous catheter, it was necessary to insert a midline catheter. A complete ultrasound evaluation showed that only the axillary vein was suitable for direct cannulation. To avoid creating an exit site in the axillary cavity, the decision was made to tunnel the catheter to locate an exit site in a safer position. A guidewire was introduced through a needle in the axillary vein. A tunnel was created using a subcutaneous injection of lidocaine. A 14 G/13.3 cm peripheral venous catheter was inserted in the subcutaneous tract. A 4 Fr/20 cm catheter was introduced through the peripheral venous catheter and moved to the axillary vein through the previously inserted sheath. No acute complications occurred. The catheter was accessed several times a day during the period following its insertion to infuse drugs and take blood samples. It was removed 50 days after its placement because it was no longer needed. No symptomatic thrombosis or infections occurred.
: The placement of the tunnelled midline catheter is shown to be a safe and effective way to ensure vascular access for almost 2 months.
对于静脉穿刺困难的患者，一种安全且广泛应用的做法是在超声引导下将导管置入更深的静脉。然而，当导管与静脉的比例过高或插入部位位于具有特定解剖/生理特征的区域时，并发症的风险会增加。
一名60岁女性在心脏手术后入住术后重症监护病房，术后病程复杂。拔除中心静脉导管后，需要插入一根中线导管。完整的超声评估显示，只有腋静脉适合直接插管。为避免在腋窝腔内形成出口部位，决定将导管做成隧道状，以便在更安全的位置找到出口部位。通过一根针将导丝引入腋静脉。通过皮下注射利多卡因形成一条隧道。将一根14G/13.3cm的外周静脉导管插入皮下通道。通过外周静脉导管引入一根4Fr/20cm的导管，并通过先前插入的鞘管将其移至腋静脉。未发生急性并发症。在导管插入后的一段时间内，每天多次使用该导管输注药物和采集血样。由于不再需要，在放置50天后将其拔除。未发生有症状的血栓形成或感染。
隧道式中线导管的放置被证明是一种安全有效的方法，可确保近2个月的血管通路。
