Bersten A D, Williams D R, Phillips G D
Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, South Australia.
Anaesth Intensive Care. 1988 Aug;16(3):342-51. doi: 10.1177/0310057X8801600317.
Delayed central venous perforation is an uncommon but serious complication of central venous catheter insertion. An increase in catheter stiffness may have been responsible for our association of venous perforation with use of a guidewire insertion technique. A bench model was used to investigate the stiffness characteristics of thirty-four different types of catheters. The initial stiffness is poorly described by material or catheter gauge. A large range of values is seen between apparently similar catheters--the 16 gauge polyethylene catheter associated with two perforations at our institution had an initial stiffness value 7.5 Nm2 X 10(-5) at 37 degrees C in comparison with our previous standard--the 16 gauge Deseret Intracath with an initial stiffness of 2 Nm2 X 10(-5). Multilumen catheters had a similar range of stiffness to single lumen catheters, while paediatric catheters in general were less stiff. Dialysis catheters were up to five times as stiff as the stiffest central venous catheter. Stiffness decayed at a rate and to an extent which differed from catheter to catheter. Absorption of water by the catheter appears to be one factor involved in stress relaxation.
延迟性中心静脉穿孔是中心静脉导管插入术一种罕见但严重的并发症。导管硬度增加可能是我们观察到静脉穿孔与使用导丝插入技术有关的原因。我们使用一个实验台模型来研究34种不同类型导管的硬度特性。材料或导管规格并不能很好地描述初始硬度。在外观相似的导管之间可观察到很大的硬度值范围——在我们机构中，与两例穿孔相关的16号聚乙烯导管在37℃时的初始硬度值为7.5 Nm2×10(-5)，而我们之前的标准导管——16号Deseret Intracath的初始硬度为2 Nm2×10(-5)。多腔导管的硬度范围与单腔导管相似，而儿科导管总体上硬度较小。透析导管的硬度最高可达最硬的中心静脉导管的五倍。不同导管的硬度衰减速率和程度各不相同。导管对水的吸收似乎是应力松弛所涉及的一个因素。
