Fabri P J, Mirtallo J M, Ebbert M L, Kudsk K A, Powell C, Ruberg R L
JPEN J Parenter Enteral Nutr. 1984 Nov-Dec;8(6):705-7. doi: 10.1177/0148607184008006705.
Radiographic evidence of subclavian vein thrombosis has been shown to occur in 33% of total parenteral nutrition patients. This incidence can be significantly reduced to 8% when heparin is administered concomitantly in total parenteral nutrition solutions. To evaluate the thrombotic risk of a newly developed polyurethane catheter, 20 concurrent patient pairs were prospectively cannulated with either a standard polyethylene catheter plus heparin or a polyurethane catheter without heparin in a sequential statistical study. Radionuclide venograms (Tc99m) were performed within 72 hr of catheterization, at biweeky intervals, and at termination of total parenteral nutrition administration. No patient in either group developed clinical (pain, arm swelling, collateral veins) or venogram evidence of thrombosis after catheterization during an overall cannulation period of 820 days. Use of polyurethane catheters and elimination of heparin in total parenteral solutions may be particularly important since contraindications to heparin use are common. Additionally, heparin elimination can decrease admixture work and confusion (ie, subcutaneous heparin double dosing) without increasing the risk of subclavian vein thrombosis.
锁骨下静脉血栓形成的影像学证据显示，在全胃肠外营养患者中发生率为33%。当在全胃肠外营养液中同时使用肝素时，这一发生率可显著降至8%。为评估一种新开发的聚氨酯导管的血栓形成风险，在一项序贯统计研究中，前瞻性地为20对同期患者分别插入标准聚乙烯导管加肝素或不含肝素的聚氨酯导管。在插管后72小时内、每两周以及全胃肠外营养给药结束时进行放射性核素静脉造影（Tc99m）。在820天的总插管期内，两组患者在插管后均未出现临床（疼痛、手臂肿胀、侧支静脉）或静脉造影证实的血栓形成证据。使用聚氨酯导管并在全胃肠外营养液中不用肝素可能尤为重要，因为肝素使用的禁忌证很常见。此外，不用肝素可减少混合操作和混淆（如皮下肝素重复给药），而不会增加锁骨下静脉血栓形成的风险。
