Karnik R, Valentin A, Winkler W B, Donath P, Slany J
Second Department of Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Clin Cardiol. 1993 Jan;16(1):26-9. doi: 10.1002/clc.4960160106.
Venous thrombosis is a very common complication of central venous catheters inserted via the jugular or subclavian vein. The aim of this prospective study is to test the suitability of duplex sonography in detecting thrombi in the internal jugular vein after catheter removal and to analyze the number and extent of such thrombus formations. The study group comprised 64 consecutive patients with an average age of 59 +/- 16 years admitted to an internal intensive care unit. In 54 cases the catheters were removed under sonographic control. In 10 cases duplex sonography was carried out within 24 h after removal of the catheters. The data of 63 patients were evaluated. In 40 patients (63.5%), thrombi of varying extent were present in the jugular vein. No significant correlations were found between thrombus formation and the basic disease, duration of cannulation, the type of catheters used, and the mode of heparinization (therapeutic vs. low-dose). Local inflammation signs and local hematoma showed a significantly higher incidence (p < 0.01) in patients with thrombus formation. Duplex sonography lends itself as a valuable diagnostic tool in the diagnosis of thrombus formation in the internal jugular vein after removal of central venous catheters. Sonographic examinations should be carried out in all long-stay patients at an intensive care unit, in whom central venous catheters are inserted repeatedly via the internal jugular vein.
静脉血栓形成是经颈内静脉或锁骨下静脉插入中心静脉导管后非常常见的并发症。这项前瞻性研究的目的是检验双功超声在检测拔除导管后颈内静脉血栓方面的适用性，并分析此类血栓形成的数量和范围。研究组包括64例连续入住内科重症监护病房的患者，平均年龄为59±16岁。54例患者在超声引导下拔除导管。10例患者在拔除导管后24小时内进行了双功超声检查。对63例患者的数据进行了评估。40例患者（63.5%）颈内静脉存在不同程度的血栓。血栓形成与基础疾病、置管时间、所用导管类型以及肝素化方式（治疗性与小剂量）之间未发现显著相关性。血栓形成患者的局部炎症体征和局部血肿发生率显著更高（p<0.01）。双功超声是诊断拔除中心静脉导管后颈内静脉血栓形成的一种有价值的诊断工具。对于所有在内科重症监护病房长期住院且经颈内静脉反复插入中心静脉导管的患者，均应进行超声检查。
