中心静脉导管拔除障碍及其对策

Removal obstacles of central venous catheter and its countermeasures

经皮下隧道带涤纶套中心静脉导管(TCC)在透析患者的使用越来越广泛,使用过程中各种原因可能导致导管拔除障碍,其中导管嵌顿、粘连导致的导管拔除障碍引起临床关注。导管嵌顿是指当TCC涤纶套分离后,导管在深静脉出现的粘连,可致导管拔除障碍。造成导管嵌顿的主要原因可能是纤维鞘的形成,后期钙化的发生也可加重导管嵌顿;此外,留置导管时间大于2年及中心静脉狭窄病史,也可显著增加导管拔除障碍的发生率。本文综述导管嵌顿的常见危险因素,及导管拔除障碍的对策和预防。

Tunneled cuff catheters（TCC） have been commonly used in dialysis patients. However, this process use may cause the removal obstacles of central venous catheter due to variety of reasons, among them, stuck catheter and adhesion have been paid more attention. Stuck catheter means adhesion of the catheter to the central venous when the cuff of the TCC is separated, which may lead to removal obstacles. This stuck catheter might be due to the formation of fibrin sheath and the later calcification, which can result in more severe catheter incarceration. Usually, the TCC used over two years, or the patient with central venous stenosis may significantly increase the incidence rate of removal obstacles. This review describes common risk factors of stuck catheter, and the countermeasures for the removal obstacles of central venous catheter.