Malatinský J, Kadlic T, Májek M, Sámel M
Acta Anaesthesiol Scand. 1976;20(3):237-47. doi: 10.1111/j.1399-6576.1976.tb05035.x.
Exact placement is an essential prerequisite for long-term use of a central venous catheter. Reported data show an extremely wide range of catheteral misplacements: from less than 1% to more than 60%. Some approaches appear to be less advantageous than others, but the highest rates of misplacement occur in the cubital, external jugular and saphenous veins. A series is presented of 378 radiographically controlled central venous catheters analysed for aberrant placement and loop formation. The total occurrence of faulty positioning and coiling reached 5.3%, while the respective incidences were 30% for the external jugular vein, 5.7% for the internal jugular vein, 5.5% for the infraclavicular technique of subclavian venepuncture, 5.3% for the innominate vein and 1.4% for the supraclavicular approach of subclavian venepuncture. The total frequency for pure loop formation was 2.9%. The authors discuss numerous reported data on catheter malpositioning, according to the specific techniques used, and compare them with thier own results. The relatively low incidence in the present series is possibly due to the high proportion of cases where the supraclavicular subclavian approach was used, the omission of the sphrenous/femoral and cubital techniques, and to pre-determining the length of the inserted catheteral segments.
准确放置是长期使用中心静脉导管的重要前提条件。报告数据显示导管误置的范围极广：从不到1%至超过60%。一些方法似乎不如其他方法有利，但误置率最高的是肘静脉、颈外静脉和大隐静脉。本文报道了378根经放射学控制的中心静脉导管，分析其异常放置和形成袢的情况。定位错误和盘绕的总发生率为5.3%，其中颈外静脉的发生率为30%，颈内静脉为5.7%，锁骨下静脉穿刺的锁骨下技术为5.5%，无名静脉为5.3%，锁骨下静脉穿刺的锁骨上技术为1.4%。单纯形成袢的总发生率为2.9%。作者根据所使用的具体技术，讨论了大量关于导管位置不当的报告数据，并将其与自己的结果进行了比较。本系列中相对较低的发生率可能是由于使用锁骨上锁骨下方法的病例比例较高、未采用大隐静脉/股静脉和肘静脉技术以及预先确定插入导管段的长度。
