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因插入Swan-Ganz导管导致原有中心静脉导管二次移位——病例报告

Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion - A case report.

作者信息

Cho Joonho, Yoo Byung Hoon, Park Jihwan, Lim Yun Hee, Jun In-Jung, Kim Kye-Min

机构信息

Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.

出版信息

Anesth Pain Med (Seoul). 2023 Jan;18(1):46-50. doi: 10.17085/apm.22212. Epub 2023 Jan 10.

DOI:10.17085/apm.22212
PMID:36746901
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9902637/
Abstract

BACKGROUND

The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.

CASE

A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.

CONCLUSIONS

After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.

摘要

背景

多条中心静脉导管缠结是一种罕见且严重的并发症。Swan-Ganz导管是多种此类情况的诱因。

病例

一名66岁男性患者在全身麻醉下接受冠状动脉搭桥手术。由于其右锁骨下静脉已留置Perm导管，故将Swan-Ganz导管插入左颈内静脉。置管后胸部X线片显示Perm导管已迁移至左头臂静脉。外科医生试图手动重新放置，但术后X线片显示其已卷成一个环。术后第1天，进行了放射介入以解开该环，手术成功。

结论

在已有中心静脉导管的患者中置入Swan-Ganz导管后，应评估是否存在缠结。在此类情况下，建议进行放射学引导下的纠正，因为盲目尝试解开可能会使情况恶化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/f11153a9d7e2/apm-22212f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/55df4a8623a3/apm-22212f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/9f0c678d743b/apm-22212f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/44ec5d255559/apm-22212f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/f11153a9d7e2/apm-22212f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/55df4a8623a3/apm-22212f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/9f0c678d743b/apm-22212f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/44ec5d255559/apm-22212f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/760f/9902637/f11153a9d7e2/apm-22212f4.jpg

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本文引用的文献

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A Rare and Unique Central Line Complication.一种罕见且独特的中心静脉置管并发症。
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):676-677. doi: 10.1053/j.jvca.2020.06.029. Epub 2020 Jun 15.
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Central venous catheter malposition due to dialysis catheter: a case report.透析导管导致中心静脉导管位置异常：一例病例报告。
Korean J Anesthesiol. 2016 Oct;69(5):532-534. doi: 10.4097/kjae.2016.69.5.532. Epub 2016 Aug 18.
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Knotting of two central venous catheters: a rare complication of pulmonary artery catheterization.两根中心静脉导管打结：肺动脉导管插入术的一种罕见并发症。
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Complications associated with pulmonary artery catheters: a comprehensive clinical review.肺动脉导管相关并发症：全面临床综述。
Scand J Surg. 2009;98(4):199-208. doi: 10.1177/145749690909800402.
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Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery.Swan-Ganz导管在心脏手术中引发的严重并发症：右心室穿孔、打结及肺动脉破裂。
J Card Surg. 2006 May-Jun;21(3):292-5. doi: 10.1111/j.1540-8191.2006.00235.x.
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Knot in the cava--an unusual complication of swan-ganz catheters.腔静脉内打结—— Swan-Ganz导管的一种罕见并发症。
Eur J Vasc Endovasc Surg. 2005 Jun;29(6):651-3. doi: 10.1016/j.ejvs.2005.02.017. Epub 2005 Mar 26.
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Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution.肺动脉导管在上腔静脉内打结：手术取出及一则警示
Heart. 2004 May;90(5):e28. doi: 10.1136/hrt.2003.031997.
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True knot in a Swan-Ganz catheter on a central venous catheter: a simple trick for percutaneous removal.中心静脉导管上的 Swan-Ganz 导管出现真结：经皮移除的一个简单技巧。
Intensive Care Med. 1996 Aug;22(8):830-1. doi: 10.1007/BF01709529.
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Knotting of two central venous catheters: a rare complication of pulmonary artery catheterization.两根中心静脉导管打结：肺动脉导管插入术的一种罕见并发症。
Wien Klin Wochenschr. 1996;108(13):404-6.
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Intracardiac knotting of two catheters: an unusual hazard of pulmonary artery catheterization.两根导管在心腔内打结：肺动脉导管插入术的一种罕见风险。
Intensive Care Med. 1982;8(6):299-300. doi: 10.1007/BF01716743.