左颈内静脉置管误穿纵隔的处理及分析一例

Treatment and analysis of tunneled cuffed left internal jugular vein catheter tip misplaced in mediastinum:one case report

中心静脉置管技术在临床上应用广泛,其置管相关并发症也不容忽视。该例维持性血液透析患者在彩色多普勒超声引导下行左侧颈内静脉留置长期透析导管术时出现抵抗感,置管完成后回抽导管动静脉端回血不畅,术后行胸部CT及数字减影血管造影检查发现导管末端进入中纵隔内,未伤及纵隔内血管,予以20 d后导管末端血肿机化后拔除留置导管。该例提示左颈内静脉置管误穿中纵隔可致一些严重甚至致命的并发症,熟悉相关解剖结构、提高置管技术、及时行相关医技检查及治疗是防治并发症的关键。

The central venous catheterization(CVC)has been widely applied in clinical practice.However,the complications induced by CVC can not be neglected.In this article,one patient presented with resistance during the period of indwelling the tunneled cuffed left internal jugular vein catheter guided by ultrasonography and failed to achieve smooth drainage after CVC.Postoperative CT scan of the chest and DSA showed the catheter tip was misplaced in the middle mediastinum without vascular trauma.The catheter was removed at 20 d after the hematoma was organized around the tip.Malpositioning of tunneled cuffed left internal jugular vein catheter tip in the mediastinum can cause severe and even fatal complications.Intimate knowledge of anatomical structures,improvement of catheter indwelling technique,timely relevant examinations and treatment are the key to prevent and treat complications.