Malatinský J, Faybík M, Sámel M, Májek M
Resuscitation. 1983 Aug;10(4):271-81. doi: 10.1016/0300-9572(83)90029-1.
The authors have analysed the incidence of specific complications in a series of 420 intracaval catheters placed in 388 patients, using six transcutaneous puncture techniques: supraclavicular and infraclavicular subclavian, external and internal jugular, antecubital and brachiocephalic approaches. Strict and moderate criteria were used to evaluate the frequency of complications. Using strict criteria, the lowest rate of surgical complications (5%) was found with the antecubital and external jugular approach, followed by infraclavicular (6.7%) and supraclavicular (9.3%) subclavian techniques; the highest rate was seen with internal jugular (10%) and brachiocephalic (15%) routes. As to inflammatory and infectious complications, the sequence was as follows: brachiocephalic (2.5%), infraclavicular (4.4%) and supraclavicular (5.3%) subclavian, and internal jugular (7%) veins; a 10% incidence was associated with external jugular and antecubital techniques. Manifest thromboembolic complications were observed only in the brachiocephalic and antecubital groups (2.5% and 10%, respectively), the overall incidence of pulmonary embolism being 0.2%. None of the approaches used can be recommended as an exclusive method of choice. The risks of central venous catheterization should be minimalized by adherence to strict principles of placing as well as care of the indwelling intravenous catheters.
作者分析了采用六种经皮穿刺技术，为388例患者置入的420根腔静脉导管的特定并发症发生率。这六种技术分别为：锁骨上和锁骨下锁骨下入路、颈外和颈内静脉入路、肘前和头臂静脉入路。采用严格和适度的标准来评估并发症的发生频率。采用严格标准时，肘前和颈外静脉入路的手术并发症发生率最低（5%），其次是锁骨下锁骨下入路（6.7%）和锁骨上锁骨下入路（9.3%）；颈内静脉（10%）和头臂静脉（15%）入路的发生率最高。至于炎症和感染并发症，顺序如下：头臂静脉（2.5%）、锁骨下锁骨下入路（4.4%）和锁骨上锁骨下入路（5.3%）以及颈内静脉（7%）；颈外静脉和肘前入路的发生率为10%。仅在头臂静脉组和肘前组观察到明显的血栓栓塞并发症（分别为2.5%和10%），肺栓塞的总体发生率为0.2%。所采用的任何一种入路都不能被推荐为唯一的选择方法。应通过严格遵守放置原则以及对留置静脉导管的护理，将中心静脉置管的风险降至最低。
