Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit.
Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit.
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经皮中心静脉导管插入术。
DOI：
10.1001/archpedi.1990.02150350078030
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发表时间：
1990
影响因子：
--
通讯作者：
David E Fisher
中科院分区：
文献类型：
--
作者：
M. K. Chathas;J. Paton;David E Fisher
对于极低出生体重儿和禁忌喂养的婴儿，延长静脉通路是可取的。我们前瞻性地评估了317例患者在3年内放置的481根小直径静脉导管。在478个导管中，241个（50%）被放置在体重1 kg或以下的婴儿中，平均导管停留时间为13天（范围，小于1天至77天）。几乎一半（49%）的中心和胸导管（91%的放置）被非选择性地移除：43%是由于泄漏或凝血等问题，6%是由于怀疑败血症或静脉闭塞。在478例导管留置中的23例可能脓毒症发作中，6例（1.3%）被证实为导管相关脓毒症; 12例（2.5%）被证实为交替部位脓毒症。经皮中心静脉导管相关败血症的三个特定因素是导管留置时间延长（3 - 5周）、表皮葡萄球菌和体重≤ 1 kg。四个特定的因素，以替代部位脓毒症的替代感染部位的存在，早期感染（1至2周），极低的出生体重，和长期的临床不稳定。经皮中心静脉导管插入术减少了重复静脉穿刺的压力，导致并发症发生率低于手术放置中心静脉导管的报告，并导致导管败血症和替代部位败血症的特定风险因素的识别。
Prolonged venous access is desirable in very-low-birth-weight infants and infants for whom feedings are contraindicated. We prospectively evaluated 481 small-diameter venous catheters placed percutaneously in 317 patients over 3 years. Of 478 catheters, 241 (50%) were placed in infants weighing 1 kg or less. Mean catheter stay was 13 days (range, less than 1 to 77 days). Almost half (49%) of the central and thoracic catheters (91% of placements) were removed nonelectively: 43% due to problems such as leaking or clotting and 6% to suspicion of sepsis or venous occlusion. Of the 23 episodes of possible sepsis in the 478 catheter stays, six (1.3%) were confirmed catheter-related sepsis; 12 (2.5%) were confirmed alternate locus sepsis. Three factors specific to percutaneous central venous catheter-related sepsis were prolonged catheter stay (3 to 5 weeks), Staphylococcus epidermidis, and weight less than or equal to 1 kg. Four factors specific to alternate locus sepsis were presence of an alternate infection site, earlier infection (1 to 2 weeks), extremely low birth weight, and prolonged clinical instability. Percutaneous central venous catheterizations reduced the need for the stress of repeated venipuncture, resulting in lower complication rates than those reported with surgically placed central venous catheters, and leading to identification of risk factors specific to catheter sepsis and alternate locus sepsis.