中线导管相关性血栓形成（MCAT）：尖端位于腋静脉是否会增加风险？
Midline Catheter-Associated Thrombosis (MCAT): Does Tip Location in the Axillary Vein Increase Risk?
机构信息
Author Affiliations: Albert Einstein College of Medicine, Bronx, New York (Schechter); Division of Hospital Medicine, Department of Medicine (Baron, Galen, Southern ), and Department of Radiology (Gohari), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Max S. Schechter, BA, is a medical student pursuing a career in internal medicine. Mr. Schechter has been published previously in the field of outcomes research and hopes to incorporate patient safety and quality improvement into his future career in academic medicine. Sarah W. Baron, MD, MS, is a physician-scientist and expert in quality improvement who is board certified in internal medicine and clinical informatics and is a practicing internal medicine hospitalist. Dr. Baron performs quality improvement projects in the hospital setting and teaches and coaches medical learners through rigorous quality improvement projects. She has authored many manuscripts in quality improvement, as well as retrospective cohorts. Dr. Baron is an associate professor of medicine. Arash Gohari, MD, MPH, is an interventional and diagnostic radiologist. He is an associate professor with over two decades of experience teaching and studying vascular access procedures. As an expert in ultrasound vascular access, he is widely published on these topics and teaches internationally at conferences and workshops. William N. Southern, MD, MS, is the chief, Division of Hospital Medicine, Department of Medicine, at Montefiore Medical Center and Albert Einstein College of Medicine. He is a health services and patient safety researcher with decades of experience studying topics ranging from wrong patient error to AMA discharge. Dr. Southern is a professor of medicine. Benjamin T. Galen, MD, is an internal medicine hospitalist and proceduralist with over a decade of experience teaching and studying vascular access procedures. As an expert in point-of-care ultrasound and bedside procedures, he is widely published on these topics and teaches internationally at conferences and workshops. Dr. Galen is also an associate program director at the Einstein/Montefiore Internal Medicine Residency Program and an associate professor of medicine.
出版信息
J Infus Nurs. 2024;47(6):363-368. doi: 10.1097/NAN.0000000000000558. Epub 2024 Oct 30.
Midline catheters, used for short- and intermediate-term venous access, are recommended to be placed with the tip in an upper arm vein rather than more proximally, in the axillary vein. Despite guidelines recommending against proximal location of the midline catheter tip, the impact of midline catheter tip location on midline catheter-associated thrombosis (MCAT) risk is unclear. Using a retrospective cohort of hospitalized patients who not only had a midline catheter but also had a chest x-ray and venous duplex performed, the authors evaluated whether axillary vein tip location increased the risk of MCAT. Of the 41 midline catheters with tips located in an arm vein, 17 (41.5%) resulted in a thrombus versus 7 (38.9%) of the 18 midline catheters with tips located in the axillary vein. When compared to midline catheter tips located in an arm vein, midline catheter tips located in the axillary vein were not significantly more likely to result in MCAT in unadjusted analysis (odds ratio [OR] = 0.90 [95% CI, 0.29-2.79], P = .85) or adjusted analysis (OR = 0.62 [95% CI, 0.18-2.12], P = .45). These findings support emerging evidence that there does not appear to be an increased risk of MCAT in midlines with an axillary vein tip location. The practice of avoiding the axillary vein for midline catheter tip placement should be reconsidered.
中线导管用于短期和中期静脉通路，建议将尖端置于上臂静脉而不是更靠近腋窝的静脉内。尽管指南建议避免中线导管尖端位于近端，但中线导管尖端位置对中线导管相关性血栓形成（MCAT）风险的影响尚不清楚。本研究使用回顾性队列研究了住院患者，这些患者不仅有中线导管，而且还进行了胸部 X 光和静脉双功能超声检查，作者评估了腋静脉尖端位置是否会增加 MCAT 的风险。在尖端位于手臂静脉的 41 根中线导管中，有 17 根（41.5%）导致血栓形成，而尖端位于腋静脉的 18 根中线导管中有 7 根（38.9%）。与位于手臂静脉内的中线导管尖端相比，位于腋静脉内的中线导管尖端在未调整分析（比值比 [OR] = 0.90 [95% CI，0.29-2.79]，P = 0.85）或调整分析（OR = 0.62 [95% CI，0.18-2.12]，P = 0.45）中均不太可能导致 MCAT。这些发现支持了一个新出现的证据，即在中线导管尖端位于腋静脉的情况下，MCAT 的风险似乎没有增加。对于中线导管尖端放置避免使用腋静脉的做法应重新考虑。
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