West China School of Nursing/Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Nurs Crit Care. 2021 Jul;26(4):262-273. doi: 10.1111/nicc.12539. Epub 2020 Sep 1.
Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports.
To determine the clinical characteristics of paraspinal vein misplacement.
This was a systematic review.
A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted.
Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced complications, of whom seven died. The most common complications included cerebrospinal fluid abnormalities, neurological symptoms, and deteriorated respiration. Among the entire case cohort, the onset of complications was the primary sign that alerted medical staff to misplacement (n = 23). The typical radiographic characteristics were posterior deviation of the catheter course overlapping with the spine on lateral X-rays and a bend, kink, or hump in the catheter course on anteroposterior X-rays at the L4 to L5 levels.
Nurses should be aware of this particular complication if a patient who has undergone catheterization via a lower extremity presents deterioration of neurological function and respiration.
Lateral X-ray radiography is an effective method to verify misplacement and is recommended as routine practice during catheterization via lower extremities.
经下肢中心静脉置管后，脊柱旁静脉移位是一种少见的并发症，大多数病例均为个案报道。
确定脊柱旁静脉移位的临床特征。
这是一项系统综述。
从建库至 2019 年 6 月 18 日，对 PubMed、EMBASE、Scopus 和 Web of Science 数据库进行系统文献检索，纳入描述中心静脉置管误入脊柱旁静脉的个案报告和小病例系列研究。提取置管过程、导管尖端位置、并发症和影像学特征等数据。
共纳入 30 项研究，总计 36 例患者。最常见的是升胸腰静脉（n=30），其次是腰静脉（n=4）、髂腰静脉（n=1）和椎静脉丛（n=1）。6 例患者的置管过程有意外发生。26 例患者发生了与导管移位相关的并发症，其中 7 例死亡。最常见的并发症包括脑脊液异常、神经症状和呼吸恶化。在整个病例队列中，并发症的出现是引起医务人员警觉的主要征象（n=23）。典型的影像学特征为侧位 X 射线显示导管走行与脊柱重叠的后向移位，以及正位 X 射线在 L4 至 L5 水平处导管走行的弯曲、扭结或成角。
如果下肢置管的患者出现神经功能和呼吸恶化，护士应意识到这种特殊的并发症。
侧位 X 射线摄影是一种有效的验证移位的方法，建议在下肢置管时常规应用。
