Ferguson M, Max M H, Marshall W
Department of Surgery, Eastern Virginia Medical School, Norfolk.
South Med J. 1988 Apr;81(4):433-5. doi: 10.1097/00007611-198804000-00005.
We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in the emergency department. Sex, age, insertion site, blood pressure at time of insertion, indications for placement, catheters left in place, and complications were recorded. Patients with severe chest trauma or known pneumothorax or hemothorax on the ipsilateral side of line placement were excluded. The eight complications (15%) directly attributable to the procedure itself were one pneumothorax, two hematomas at the site of insertion, one knotted catheter, two misplaced catheters, and two episodes of sepsis, confirming the higher complication rates for emergency subclavian catheter insertion. Two upper extremity, 14 gauge percutaneously placed intravenous catheters are usually sufficient for resuscitation; femoral and cutdown routes offer additional sites for massive resuscitation. Subclavian catheterization is seldom needed in the emergency room. Any intravenous lines inserted in the emergency room should be changed within 24 hours to minimize infection.
我们评估了创伤和烧伤患者在急诊科放置锁骨下静脉导管的相关并发症，回顾了1983年期间通过急诊科收治到烧伤创伤科的所有441例患者的病历。52例患者（12%）在急诊科时进行了锁骨下导管的锁骨下入路放置。记录了患者的性别、年龄、插入部位、插入时的血压、放置指征、留置导管情况及并发症。排除严重胸部创伤或在置管同侧已知有气胸或血胸的患者。直接归因于操作本身的8例并发症（15%）为1例气胸、2例插入部位血肿、1例导管打结、2例导管误置和2例败血症发作，证实了急诊锁骨下导管插入术的并发症发生率较高。两根上肢14号经皮放置的静脉导管通常足以进行复苏；股静脉和切开置管途径为大量复苏提供了额外的部位。急诊室很少需要进行锁骨下置管。在急诊室插入的任何静脉输液管都应在24小时内更换，以尽量减少感染。
