Alvarado-Díez M A, Márquez-Enriquez L M, Troconis-Trens G, Serrano V, Vásquez-Gutiérrez E, Rivera-Rebolledo J C, Villegas-Silva R
Unidad de Terapia Intensiva, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F.
Bol Med Hosp Infant Mex. 1993 Jun;50(6):394-8.
To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU.
Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered.
92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter.
Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.
评估锁骨下穿刺置入股静脉导管期间及在入住重症监护病房(ICU)的儿童使用该导管期间并发症的发生频率和类型。
纳入年龄在1个月至15岁之间、入住墨西哥国立医学中心儿童医院重症监护病房且因中心静脉导管并发症接受经皮锁骨下穿刺的患者。记录该操作的临床特征、诊断、并发症及适应证。
纳入92例患者及102次锁骨下穿刺进行分析。有效率为88.3%。主要诊断为传染病(29.4%)和肿瘤(22.5%)。血流动力学监测是该操作最常见的适应证(44%)。45%的导管首次穿刺即成功置入。置管时的并发症发生率为11.7%。其中锁骨下动脉穿刺(6.8%)、血肿(2.9%),无一例出现血流动力学恶化。平均留置时间为8.8天。晚期并发症平均在7.3天出现,发生率为18.6%。以导管入口处感染为主。
锁骨下穿刺置入中心静脉导管在我们的患者中显示出很大的实用性,并发症少且有效率高。对于从事该领域的人员来说,小儿患者锁骨下穿刺中心静脉置管在危重症患儿中至关重要。