植入式静脉输液港导管断裂预防与处理

Catheter fracture of implantable central venous access port: its prevention and management

目的探讨植入式静脉输液港(IVAP)导管断裂及其预防处理。方法回顾性分析2012年1月至12月单中心878例IVAP植入患者中发生导管断裂7例患者临床资料,结合相关文献对导管断裂原因和预防措施进行讨论。结果截至2016年11月31日,经颈内静脉植入IVAP术后导管断裂发生率为0.8%(7/878);断裂时间为术后855~1 412 d,平均1 133 d;断裂部位为导管进入颈内静脉交界处、导管与底座接头处和皮下隧道部位。结论导管断裂是IVAP植入后长期使用过程中严重并发症之一。规范手术操作流程、加强维护和护理宣教、适时取出等措施,有助于降低IVAP导管断裂发生率,保障患者生命安全。

Objective To discuss the prevention and treatment of catheter fracture of implantable venous access port （IVAP）. Methods A total of 878 adult patients, who received IVAP during the period from January 2012 to December 2012 in a single medical center, were collected. Among the 878 patients, catheter fracture occurred in 7 patients. The clinical data of the 7 patients were retrospectively analyzed. By referring to the related literature, the causes and the prevention measures for catheter fracture were discussed. Results As of November 31, 2016, the catheter fracture rate of IVAP, which was implanted via internal jugular vein （IJV）, was 0.8% （7/878）. The fracture occurrence time was 855-1512 days after implantation of IVAP, with a mean of 1133 days. The common fracture sites were catheter-IJV junction, catheter-IVAP base joint, and subcutaneous tunnel segment. Conclusion Catheter fracture is one of the serious complications which occur in the course of long-period use of IVAP after its implantation. Standardization of operative procedure, strengthening of the maintenance and nursing education, timely removal of IVAP, and other necessary measures can help reduce the incidence of IVAP catheter fracture and ensure the safety of patients. （J Intervent Radiol, 2017, 26： 702-705）