Doerffel Annika, Reinert Anja, Böttcher Denny, Winter Karsten, Brehm Walter, Gittel Claudia
Klinik für Pferde, Veterinärmedizinische Fakultät, Universität Leipzig.
Veterinär-Anatomisches Institut, Veterinärmedizinische Fakultät, Universität Leipzig.
Tierarztl Prax Ausg G Grosstiere Nutztiere. 2022 Apr;50(2):101-114. doi: 10.1055/a-1809-6477. Epub 2022 May 6.
Complications associated with indwelling intravenous catheters vary from minor to severe. Changes in tissue architecture and vein structure may be detectable prior to clinical alterations. The aim of the study was to characterize and compare changes in a catheterized vein and surrounding tissue by clinical and ultrasonographic examination. Microbiological infestation of catheter specimens was assessed.
In this prospective, observational, clinical study 55 horses with an indwelling intravenous catheter have been included. Subsequent to catheter placement, vein and surrounding tissue were daily examined clinically and by ultrasonographic examination at predetermined localizations. After sterile removal of the catheters, specimens underwent microbiological testing and scanning electron microscopy. Obtained data were analyzed via descriptive statistics. Thickness of the venous wall was compared at predetermined localizations and time points for several parameters with the help of non-parametric tests (level of significance at p < 0.05, post-hoc Bonferroni correction).
Overall, in 41.8 % of the horses transient alterations (swelling) of the surrounding tissue occurred during catheterization. Median catheterization was 69.5 hours (19 hour-10 days). With ultrasonography, venous valves and collateral vessels could be detected reliably. Significant alterations in wall thickness during catheterization were associated with various factors (location site [p ≤ 0.001], season [p = 0.006], anesthesia [p ≤ 0.001]).Microbiological analysis revealed a positive result in 23.5 %, 12 of the 51 samples; raster electron microscopy showed presence of bacteria in 25.0 %, 4 of the 16 investigated catheter samples.
Local tissue changes at the insertion site of the catheter are commonly associated with catheterization, and are easily detectable with ultrasonography. Despite the easy performance in a clinical setting, the benefit of routine ultrasonographic monitoring of catheterized veins might be questionable with regard to early identification and prediction of catheter-associated venous disease. Bacteria might be detectable morphologically on the catheter but frequently lack a positive result from standard bacterial cultivation.
留置静脉导管相关并发症从轻微到严重不等。在临床改变之前，组织结构和静脉结构的变化可能就已可检测到。本研究的目的是通过临床和超声检查来描述和比较置管静脉及周围组织的变化。评估导管标本的微生物感染情况。
在这项前瞻性、观察性临床研究中，纳入了55匹留置静脉导管的马。导管置入后，每天在预定部位对静脉和周围组织进行临床及超声检查。无菌取出导管后，对标本进行微生物检测和扫描电子显微镜检查。通过描述性统计分析获得的数据。借助非参数检验（显著性水平为p < 0.05，事后邦费罗尼校正），在预定部位和时间点比较几个参数下静脉壁的厚度。
总体而言，41.8%的马在置管期间周围组织出现短暂改变（肿胀）。置管的中位时间为69.5小时（19小时 - 10天）。通过超声检查，可以可靠地检测到静脉瓣膜和侧支血管。置管期间壁厚度的显著改变与多种因素相关（置管部位[p ≤ 0.001]、季节[p = 0.006]、麻醉[p ≤ 0.001]）。微生物分析显示23.5%（51个样本中的12个）结果为阳性；扫描电子显微镜显示16个被研究的导管样本中有25.0%（4个）存在细菌。
导管插入部位的局部组织变化通常与置管有关，且通过超声检查易于检测到。尽管在临床环境中操作简便，但对于早期识别和预测导管相关静脉疾病而言，常规超声监测置管静脉的益处可能存在疑问。在导管上可能在形态学上检测到细菌，但标准细菌培养结果往往为阴性。
