Venkataraman S T, Thompson A E, Orr R A
Department of Anesthesiology/Critical Care Medicine and Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh, PA, USA.
Clin Pediatr (Phila). 1997 Jun;36(6):311-9. doi: 10.1177/000992289703600601.
The success rate and complications from femoral arterial and venous catheterization in infants and children in a university affiliate pediatric intensive care unit were determined prospectively over a 2-year period. We also performed a meta-analysis from published literature to determine the combined estimates of noninfectious and infectious complications (with 95% confidence limits) using the inverse variance-weighted method. Success rates were 94.5% and 94.4% for femoral arterial (n=110) and venous (n=89) catheterizations, respectively, and were related to operator expertise, age, and hemodynamic status. Median age was 2.4 years and 1.1 year for arterial and venous catheterizations, respectively. Immediate complications were hematoma (10.9% arterial, 16.8% venous) and minor bleeding (13.6% arterial, 13.5% venous). Decreased pulses occurred with 7.7% of arterial catheterizations, and lower limb swelling occurred in 9.5% of venous catheterizations. Vascular complications occurred only in infants and resolved within 7-14 days. Catheter-related infections occurred in 1.9% of arterial and 3.6% of venous catheterizations. The mean duration of catheterization was 5.3 days and 6.3 days with femoral arterial and venous catheterizations, respectively. Meta-analysis of published studies shows that the estimates for noninfectious complications were 5.0%, 10.1%, 1.1%, and 1.8% for femoral arterial, femoral venous, axillary arterial, and nonfemoral venous catheters, respectively. The estimates for catheter-related infection were 2.5%, 3.7%, and 3.0% for femoral arterial, femoral venous, and nonfemoral venous catheters, respectively. The meta-analytic estimates for complication rates from published literature are not significantly different from the rates observed in our study. Femoral arterial and venous catheterization in infants and children are safe with an expected high success rate and acceptably low complication rates.
在一所大学附属医院的儿科重症监护病房中，对婴幼儿股动脉和股静脉置管的成功率及并发症进行了为期2年的前瞻性研究。我们还对已发表文献进行了荟萃分析，采用逆方差加权法确定非感染性和感染性并发症的综合估计值（95%置信区间）。股动脉置管（n = 110）和股静脉置管（n = 89）的成功率分别为94.5%和94.4%，与操作者的专业技能、年龄和血流动力学状态有关。动脉和静脉置管的中位年龄分别为2.4岁和1.1岁。即刻并发症包括血肿（动脉置管为10.9%，静脉置管为16.8%）和轻微出血（动脉置管为13.6%，静脉置管为13.5%）。7.7%的动脉置管出现脉搏减弱，9.5%的静脉置管出现下肢肿胀。血管并发症仅发生在婴儿中，且在7 - 14天内消退。导管相关感染在动脉置管中发生率为1.9%，在静脉置管中发生率为3.6%。股动脉和股静脉置管的平均置管时间分别为5.3天和6.3天。对已发表研究的荟萃分析表明，股动脉、股静脉、腋动脉和非股静脉导管的非感染性并发症估计值分别为5.0%、10.1%、1.1%和1.8%。股动脉、股静脉和非股静脉导管的导管相关感染估计值分别为2.5%、3.7%和3.0%。已发表文献中并发症发生率的荟萃分析估计值与我们研究中观察到的发生率无显著差异。婴幼儿股动脉和股静脉置管是安全的，成功率高，并发症发生率低且可接受。
