Abstract
One hundred and twenty-three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were compared. The operating time needed for introducing the catheter by the closed technique (average, 51 minutes) was significantly shorter (p < 0.001) than the time needed for the open technique (70 minutes), whereas complication rates were equal in both techniques. On average, the catheters functioned for 149 days. Complications leading to removal were observed in 29.3% of patients, most of which were catheter-related infections (20.4%). Thromboembolic complications leading to removal were less frequent (4.1%) and appeared significantly earlier (p <0.001). These data indicate that introduction of the catheter by direct puncture of the subclavian vein is a quick and safe technique, and that this type of catheter is suitable for long-term use, both for infusion and for blood sampling.
Résumé
Cent vingt-trois cathéters en caoutchouc siliconé à double lumière ont été mis en place afin de traiter 101 patients ayant une maladie hématologique grave nécessitant une thérapeutique lourde. Le taux de complications péri-opératoires était de 13%. L'étude a comparé 2 techniques d'insertion: avec ou sans abord direct. La durée de l'intervention utilisant la technique sans abord direct (51 minutes en moyenne) était significativement plus courte que celle de la technique avec abord direct (70 minutes) (p<0.001), alors que le taux de complications était similaire dans les 2 groupes. Les cathéters sont restés fonctionnels pendant 149 jours en moyenne. Des complications ont nécessité l'ablation du cathéter dans 29.3% des cas (infection le plus souvent: 20.4%). Ensuite, venaient les complications thromboemboliques (4.1%), mais, qui survenaient plus tôt dans la période postopératoire (p<0.001). Nos résultats suggèrent que: la technique d'introduction des cathéters par insertion directe dans la veine sous-clavière est rapide et sûre, et ce type de cathéter est bien adapté à l'utilisation de longue durée, à la fois pour perfuser et pour prélever.
Resumen
Ciento veintrés catéteres venosos centrales de caucho siliconizado fueron colocados en 101 pacientes con neoplasias hematológicas malignas sometidos a tratamiento intensivo. La tasa de complicaciones perioperatorias fue de 13%. Se efectuó la comparación entre las técnicas de inserción abierta y cerrada. El tiempo operatorio utilizado para la inserción del catéter mediante la técnica cerrada (51 minutos en promedio) fué significativamente mas corto (p<0.001) que el empleado para la inserción con la técnica abierta (70 minutos), en tanto que las tasas de complicaciones fueron iguales. En promedio los catéteres funcionaron durante 149 días. Se presentaron complicaciones que obligaron a su remoción en 29.3% de los casos, la mayoría relacionada con infecciones relativas al catéter (20.4%). Las complicaciones tromboembólicas que hicieron necesaria la remoción fueron menos frecuentes (4.1%) e hicieron su aparición considerablemente más pronto (p< 0.001). Estos datos indican que: la inserción del catéter por punción directa de la vena subclavia es un método rápido y seguro, y este tipo de catéter es adecuado para uso a largo plazo, tanto para efectos de la infusión como de muestreo de sangre.
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Jansen, R.F.M., Wiggers, T., van Geel, B.N. et al. Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies. World J. Surg. 14, 101–104 (1990). https://doi.org/10.1007/BF01670555
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DOI: https://doi.org/10.1007/BF01670555