Everitt N J, McMahon M J
Nutritional Support Service, General Infirmary at Leeds.
Ann R Coll Surg Engl. 1997 May;79(3):221-4.
Previous studies indicated that the risk of thrombophlebitis associated with continuous infusion of intravenous nutrition (IVN) via peripheral veins was reduced when fine-bore catheters, inserted to 15 cm, were used in place of standard intravenous cannulas. An explanation has not been identified, but may be owing to the greater length of the catheters. A randomised controlled study was performed in which a standard nutritional solution was infused via 22G polyurethane catheters inserted to a length of either 5 cm or 15 cm. Catheters were reviewed twice each day and removed when complications occurred, or when IVN was no longer required. There was no significant difference in median time to thrombophlebitis or extravasation, or in daily risk of thrombophlebitis, between insertion lengths. Survival proportions were similar for each length at all times. Catheters inserted into cephalic veins were more prone to thrombophlebitis or extravasation (nine episodes, 14 catheters) than catheters inserted into basilic veins (five episodes, 24 catheters, P = 0.009). The survival proportion was at all times greater when catheter tips lay in basilic veins. Thus, the risk of thrombophlebitis or extravasation was not influenced by the length of catheter within the vein. However, the vein in which the catheter tip lay appeared to influence the development of morbidity.
先前的研究表明，使用插入深度为15 cm的细孔导管代替标准静脉套管持续输注外周静脉肠外营养（IVN）时，血栓性静脉炎的风险会降低。目前尚未找到原因，但可能与导管较长有关。开展了一项随机对照研究，通过插入深度为5 cm或15 cm的22G聚氨酯导管输注标准营养溶液。每天对导管进行两次检查，出现并发症或不再需要IVN时将导管拔除。不同插入深度在血栓性静脉炎或外渗的中位时间以及血栓性静脉炎的每日风险方面无显著差异。各深度的存活比例在任何时候都相似。与插入贵要静脉的导管（5例，24根导管）相比，插入头静脉的导管更易发生血栓性静脉炎或外渗（9例，14根导管，P = 0.009）。当导管尖端位于贵要静脉时，存活比例在任何时候都更高。因此，血栓性静脉炎或外渗的风险不受静脉内导管长度的影响。然而，导管尖端所在的静脉似乎会影响并发症的发生。
