中心静脉置管临床应用202例体会

Clinical application of central venous catheterization:A report of 202 cases

目的：通过２０２例中心静脉置管的临床应用，对各种导管、静脉途径及置管方法加以比较，指导临床选用。方法：导管采用硅胶管、套管针及商品导管，静脉选用锁骨下静脉、颈内静脉、颈外静脉及股静脉，穿刺方法按“黎介寿”“蒋朱明”法。结果：成功率颈内静脉１００％，锁骨下静脉８８％；并发症１９例，主要为导管阻塞。２１例经Ｘ线透视导管位置满意。结论：导管以商品聚氨酯导管为佳，静脉以锁骨下静脉首选；失败后可借助动脉搏动及超声检查指导操作或改用颈内静脉。

Objective:Central venous catheterizations was performed in 202 clinical cases for comparing the different kinds of catheter,venous pathway and methods of catheterization,as guide for clinical practice.Methods:Different kinds of catheter were used silica gel tube,cannula ARROW or BRAUN.Veins chosen for insertion were subclavian vein,internal jugular vein or external jugular vein.The methods used for catheterization were those of Li Jieshou and Jiang Zhuming.Results:Success rate was 100% in internal jugular vein,88% in subclavian vein.Complication occurred in 19 cases and most of them were due to obstruction of catheters.21 catheters of ARROW and BRAUN were X rayed and their positions were normal.Conclusion:The best catheter is the one made of polyurethane.Subclavian vein is of first choice.In case of puncture failures,arterial pulse and ultrasonic detection can be used to guide the puncture or change for internal jugular vein.