Coskun Abuzer, Hıncal Sakir Ömür, Eren Sevki Hakan
Emergency Medicine Clinic, SBU Istanbul Bağcılar Training and Research Hospital, Istanbul 34200, Turkey.
Department of Emergency, Gaziantep University Medical Faculty, Gaziantep 27410, Turkey.
World J Crit Care Med. 2021 Jul 9;10(4):120-131. doi: 10.5492/wjccm.v10.i4.120.
Central venous catheterization is currently an important procedure in critical care. Central catheterization has important advantages in many clinical situations. It can also lead to different complications such as infection, hemorrhage, and thrombosis. It is important to investigate critically ill patients undergoing catheterization.
To evaluate the characteristics, such as hospitalization, demographic characteristics, post-catheterization complications, and mortality relationships, of patients in whom a central venous catheter was placed in the emergency room.
A total of 1042 patients over the age of 18 who presented to the emergency department between January 2005 and December 2015 were analyzed retrospectively. The patients were divided into three groups, jugular, subclavian, and femoral, according to the area where the catheter was inserted. Complications related to catheterization were determined as pneumothorax, guidewire problems, bleeding, catheter site infection, arterial intervention, and sepsis. Considering the treatment follow-up of the patients, three groups were formed as outpatient treatment, hospitalization, and death.
The mean age of the patients was 60.99 ± 19.85 years; 423 (40.6%) of them were women. Hospitalization time was 11.89 ± 16.38 d. There was a significant correlation between the inserted catheters with gender ( = 0.009) and hospitalization time ( = 0.040). Also, blood glucose, blood urea nitrogen, creatinine, and serum potassium values among the biochemical values of the patients who were catheterized were significant. A significant association was observed in the analysis of patients with complications that develop according to the catheter region ( = 0.001) and the outcome stage ( = 0.001). In receiver operating characteristic curve analysis of hospitalization time and mortality area under curve was 0.575, the 95% confidence interval was 0.496-0.653, the sensitivity was 71%, and the specificity was 89% ( = 0.040).
Catheter location and length of stay are important risk factors for catheter-borne infections. Because the risk of infection was lower than other catheters, jugular catheters should be preferred at entry points, and preventive measures should be taken by monitoring patients closely to reduce hospitalization infections.
中心静脉置管术目前是重症监护中的一项重要操作。中心静脉置管在许多临床情况下具有重要优势。它也可能导致不同的并发症，如感染、出血和血栓形成。对接受置管的重症患者进行调查很重要。
评估在急诊室放置中心静脉导管的患者的特征，如住院情况、人口统计学特征、置管后并发症及死亡率关系。
回顾性分析2005年1月至2015年12月期间到急诊科就诊的1042例18岁以上患者。根据导管插入部位将患者分为三组，即颈内静脉组、锁骨下静脉组和股静脉组。与置管相关的并发症确定为气胸、导丝问题、出血、导管部位感染、动脉介入和脓毒症。考虑患者的治疗随访情况，分为门诊治疗、住院治疗和死亡三组。
患者的平均年龄为60.99±19.85岁；其中423例（40.6%）为女性。住院时间为11.89±16.38天。所插入的导管与性别（P = 0.009）和住院时间（P = 0.040）之间存在显著相关性。此外，置管患者的生化指标中血糖、血尿素氮、肌酐和血清钾值具有显著性。在根据导管区域（P = 0.001）和结局阶段（P = 0.001）发生并发症的患者分析中观察到显著关联。在住院时间和死亡率的受试者工作特征曲线分析中，曲线下面积为0.575，95%置信区间为0.496 - 0.653，敏感性为71%，特异性为89%（P = 0.040）。
导管位置和住院时间是导管相关感染的重要危险因素。由于颈内静脉导管的感染风险低于其他导管，在置管部位应首选颈内静脉导管，并应通过密切监测患者采取预防措施以减少住院感染。
