Robinson J F, Robinson W A, Cohn A, Garg K, Armstrong J D
Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Arch Intern Med. 1995 Jun 12;155(11):1225-8.
Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided.
We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome.
Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation.
Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.
放置中心静脉导管以进行多种治疗已成为常见的操作。该操作最严重的并发症是大血管穿孔，可导致出血、液体输注到血管外部位以及死亡。目前可得的数据尚不清楚这种情况发生的频率、相关的危险因素以及如何避免这种并发症。
我们回顾了1986年至1993年间在丹佛科罗拉多大学健康科学中心的主要教学机构大学医院放置中心静脉导管期间被确定发生大血管穿孔的所有患者的记录。收集的数据包括患者的年龄和性别、诊断、导管类型和放置部位、操作者的方法以及穿孔诊断时间和结果。
共确定了11例此类并发症，其中10例进行了详细回顾。总体发生率低于1%。大多数并发症发生在尝试右锁骨下静脉穿刺途径时，被认为是由于血管扩张器推进过程中导丝扭结所致。涉及所有医学专业和培训水平。10例患者中有4例死于穿孔的即刻或后续并发症。
大血管穿孔是放置中心静脉导管时一种罕见但常致命的并发症。最常发生在使用右锁骨下静脉穿刺途径时，原因是导丝扭结。进行该操作的医生应接受中心静脉置管的正规培训，并了解这种并发症、其推测原因、诊断和治疗方法。
