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左颈内静脉置管后迟发性静脉撕裂:1 例报告。

Late venous laceration after inappropriate placement of a left internal jugular hemodialysis catheter: a case report.

机构信息

Department of Nephrology, Zhabei Central Hospital of JingAn District of Shanghai, Shanghai, China.

Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.

出版信息

J Int Med Res. 2022 Apr;50(4):3000605221093305. doi: 10.1177/03000605221093305.

Abstract

Central venous catheterization is a necessary and common method of building the circulation pathways of patients with end-stage kidney disease. Venous rupture is a severe and fatal complication of central venous catheterization. We herein present a case of slowly occurring venous rupture after reinsertion of a left internal jugular vein (IJV) catheter. A man in his early 70s was hospitalized with end-stage kidney disease. We inserted a hemodialysis catheter through the left IJV. A short section of the patient's catheter slipped out 1 month later. The original catheter was reinserted at its primary position without a guidewire. The patient reported chest pain and developed hypotension during dialysis the next day. He underwent femoral venous catheter insertion and heparin-free dialysis. The patient finally recovered and underwent regular hemodialysis using an arteriovenous fistula in the left forearm. This is the first reported case of venous laceration after repeated left IJV catheterization. Left IJV catheterization is associated with high rates of complications and should be closely monitored with the help of radiography during and after the operation. Central venous catheters should be carefully placed with clear knowledge of their direction and location to prevent serious complications.

摘要

中心静脉置管术是建立终末期肾病患者循环通路的必要且常用的方法。静脉破裂是中心静脉置管术的一种严重且致命的并发症。本文报告了一例左颈内静脉(IJV)导管再插入后缓慢发生静脉破裂的病例。一名 70 岁出头的男性因终末期肾病住院。我们通过左颈内静脉插入了一个血液透析导管。1 个月后,患者的一小段导管滑出。原来的导管在没有导丝的情况下重新插入到原来的位置。第二天在透析过程中,患者出现胸痛并出现低血压。他接受了股静脉导管插入术和无肝素透析。最终,患者恢复并使用左前臂动静脉瘘进行常规血液透析。这是首例报道的左颈内静脉导管重复置管后静脉撕裂的病例。左颈内静脉置管术并发症发生率高,应在术中及术后借助影像学进行密切监测。中心静脉导管应小心放置,明确其方向和位置,以防止严重并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e306/9044788/946bc3ab874f/10.1177_03000605221093305-fig1.jpg

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