植入式静脉输液港导管断裂原因分析及处理措施

Analysis of the reason and handling measures of catheter fracture of the implantable vascular access device

目的：分析完全植入式静脉输液港发生断裂的原因，探讨其预防措施及处理对策。方法回顾性分析3887例静脉输液港，在使用及维护过程中13例发生断裂的临床表现与原因，并总结成功的处理经验。结果3887例静脉输液港发生导管断裂13例占0.33%。其中经锁骨下静脉穿刺导管断裂发生率3.70%（6/162）；颈内静脉穿刺导管断裂发生率0.18%（7/3725）。颈内静脉穿刺导管断裂发生率小于锁骨下静脉穿刺（χ2＝47.505，P＝0.000），颈内静脉与锁骨下静脉穿刺左、右侧均差异无统计学意义（P＝0.707、0.682）。结论输液港断裂是输液港使用与维护过程中的严重并发症之一，通过合理选择输液港的植入途径，加强维护宣教、规范操作流程、密切观察等措施，既能减少导管断裂的发生，也能及时发现予以处理，保障患者的生命安全。

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505,P=0.000). There had no statistical differences between the left and right of the two puncture ways(P=0.707,0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life.