Sobczak Alina, Kowalik Aleksandra, Homa Marta, Turalska Patrycja, Kwinta Przemko
Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland.
Center for High Temperature Studies, Foundry Research Institute, Kraków, Poland.
J Vasc Access. 2024 Jan;25(1):158-164. doi: 10.1177/11297298221100441. Epub 2022 Jun 8.
Umbilical vessels present after birth allow a unique central access for both venous and arterial catheterization, yet the catheterization complications can be misdiagnosed as the complications of prematurity per se.
A prospective observational study of 41 used polyurethane umbilical catheters, both venous and arterial was conducted in a tertiary neonatal intensive care unit. The study consisted of bedside ultrasound imaging and post-removal microbiological and microstructural analysis to assess the in vivo catheters' changes and their clinical significance.
The study has shown that catheters' surface thrombosis and bacterial colonization happen more often within umbilical venous than within arterial catheters (31% vs 8% in both cases) and are inversely proportional to the patient's gestational age (thrombosis: Me: 28 weeks vs no thrombosis: 32 weeks; = 0.05, bacterial colonization: 27 weeks vs no colonization: 30 weeks; = 0.013), respectively. The clots formed near the catheter's tip are correlated with catheter's bacterial colonization. Chemical analysis with energy dispersive spectroscopy showed a higher calcium composition in used catheters (19.89% vs 0%, = 0.016) and structure analysis in the scanning electron microscopy proved that within hours catheters become covered with an external coating of a constant thickness, not affected by the catheterization time.
The following observations give a better insight to the complex in vivo interactions and call for a more intense bedside-monitoring of the indwelling devices.
出生后存在的脐血管为静脉和动脉导管插入术提供了独特的中心通路，但导管插入术并发症可能被误诊为早产本身的并发症。
在一家三级新生儿重症监护病房对41根使用过的聚氨酯脐静脉和动脉导管进行了一项前瞻性观察研究。该研究包括床边超声成像以及拔除后微生物学和微观结构分析，以评估体内导管的变化及其临床意义。
研究表明，导管表面血栓形成和细菌定植在脐静脉导管中比在动脉导管中更常见（两种情况分别为31%对8%），并且与患者的胎龄成反比（血栓形成：有血栓：平均28周，无血栓：32周；P = 0.05，细菌定植：有定植：27周，无定植：30周；P = 0.013）。导管尖端附近形成的凝块与导管的细菌定植相关。能量色散光谱化学分析显示使用过的导管中钙成分更高（19.89%对0%，P = 0.016），扫描电子显微镜结构分析证明，数小时内导管就会被一层厚度恒定的外部涂层覆盖，不受导管插入时间影响。
以下观察结果有助于更好地了解复杂的体内相互作用，并呼吁对留置装置进行更密切的床边监测。
