Gelonch J, Alastrué A, Monreal M, Iglesias C, Rull M, Lafoz E, Casals A, Salvá J A
Servicio de Cirugía General, Hospital Universitario Germans Trías i Pujol, Badalona (Barcelona), Universidad Autónoma de Barcelona (UAB).
Nutr Hosp. 1991 May-Jun;6(3):161-71.
The thrombogenicity presented in different types of endovenous catheters and their anomalies are the cause of the development of pulmonary thromboembolism (PTE) in some patients, secondary to deep venous thrombosis (DVT) of the upper limbs. Presentation of a study made on the incidence of PTE in patients with prior history of DVT of the upper limbs. Of the 30 cases of DVT of the upper limbs studied, 20 were directly attributed to catheters. 18 were attached to a central catheter and the other 2 one or two peripheral catheters. 0,32% of DVT of the upper limbs secondary to a central catheter was calculated. Five of the 20 DVT patients (25%) had symptomatic or sub-clinical DVT. Emphasis was placed on the importance of DVT and its intrinsically serious nature and the need for studies on this condition, since it is possible for the patient not to develop the complete symptoms of DVT at the onset, which led to death in one patient. We recommend the establishing of strict norms with regard to the indications for inserting the central catheter and the choice of the correct material, aseptic and non-traumatic insertion, radiological control (essential) of the position of the catheter and its tip, establishing of a protocol for the correct maintenance and a device for controlling thrombotic complications in upper limbs, to ensure rapid treatment and a rapid check of the possibility of DVT by pulmonary gammagraphy during the first 24-48 hours.
不同类型的静脉内导管所呈现的血栓形成倾向及其异常情况，是部分患者发生肺血栓栓塞症（PTE）的原因，这些患者上肢深静脉血栓形成（DVT）继发于此。介绍一项关于上肢DVT病史患者中PTE发病率的研究。在所研究的30例上肢DVT病例中，20例直接归因于导管。其中18例与中心静脉导管相关，另外2例与一或两根外周静脉导管相关。计算得出中心静脉导管继发的上肢DVT发生率为0.32%。20例DVT患者中有5例（25%）出现有症状或亚临床DVT。强调了DVT的重要性及其本质上的严重性，以及对此病症进行研究的必要性，因为患者在发病初期可能不会出现DVT的完整症状，有1例患者因此死亡。我们建议就中心静脉导管插入的适应证、正确材料的选择、无菌且无创的插入操作、导管及其尖端位置的放射学控制（必不可少）、正确维护的方案制定以及上肢血栓形成并发症的控制装置等建立严格规范，以确保在最初24至48小时内通过肺部γ射线造影术对DVT的可能性进行快速检查和快速治疗。
