Diaz Carime, Quintero Jaime A, Zarama Virginia, Bustamante-Cristancho Luis Alfonso
Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia.
Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia.
Open Access Emerg Med. 2023 Jan 12;15:21-28. doi: 10.2147/OAEM.S384081. eCollection 2023.
Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear.
We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications.
We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed.
A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications.
Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.
与血尿素氮（BUN）升高相关的出血是一种已知的并发症。尿毒症患者需要通过透析插入中心静脉导管。中心静脉导管插入过程中BUN与出血并发症之间的关系尚不清楚。
我们描述了尿毒症患者中心静脉导管植入相关并发症的发生率，并评估了出血并发症与导管类型、穿刺次数和导管插入部位之间的统计关系。此外，我们确定了是否有任何BUN值与出血并发症相关。
我们纳入了血清BUN值>70mg/dl且需要插入中心静脉导管的患者。定量变量通过集中趋势测量来表示。进行了双变量分析和ROC曲线分析。
本研究共纳入273根导管。69例（25.3%）检测到出血并发症，其中局部出血是最常见的并发症，共51/69例。未建立统计学上的显著关联。我们没有发现与BUN水平和并发症发生率直接相关的确切临界值。
与中心静脉导管插入相关的出血并发症以及BUN水平>70mg/dl提示的疑似止血障碍很常见。无法确定预测并发症的BUN临界值。关联分析尚无定论。在经过培训的人员在超声引导下进行中心静脉置管时，不应将高BUN水平视为高危情况。
