Doğan DEDE, Ahmet AVLUK, Nilgün YILDIRIM, İlkay AKMANGİT, Bige Sayin SEVER

Temporary Central Venous Catheter Placement with Radiological Imaging

Giriş: Kemik iliği transplantı yapılacak hastalarda, böbrek yetmezliği olgularında acil hemodiyaliz ihtiyacında, lökoferez-plazmaferez gibi yüksek volümde kan değişimi yapılacak hastalarda, damar yolu problemi olan hastalarda geçici santral venöz kateterler yaygın olarak kullanılmaktadır. Bu çalışmada radyolojik görüntüleme yöntemleri eşliğinde geçici santral venöz kateter uygulaması deneyimlerimizi literatür eşliğinde tartışmayı amaçladık. Yöntem ve Gereçler: Kliniğimizde Ocak 2007-Kasım 2009 tarihleri arasında, ultrasonografi ve floroskopi eşliğinde ve lokal anestezi sonrası geçici santral venöz kateter takılan 208 olgu retrospektif olarak incelendi. Bulgular: İki yüz sekiz hastaya 228 geçici santral venöz kateter takıldı. Hastaların %88'i kemik iliği transplantı yapılacak olan hastalardı. En sık giriş yeri sağ internal juguler vendi (%84.21). Hastaların kateter kullanma sürelerinde ortanca değer 20 gün olarak saptandı (toplam kateter kullanma süresi 4240 gün, aralık 4-34 gün). On dört olguda komplikasyon gelişti. En sık görülen komplikasyon venöz trombozdu (%2.6). Gelişen infeksiyöz komplikasyonların hepsi kemik iliği transplantı yapılacak hastalardagörüldü (%1.3). Sonuç: Geçici santral venöz kateterlerinin radyolojik görüntüleme yöntemleri eşliğinde uygulanması; komplikasyon oranlarının düşük oluşu, işlem süresinin kısa olması ve yüksek başarı oranı ile güvenilir ve etkin bir yöntemdir.

Anahtar Kelimeler:

Santral venöz kateter, geçici, komplikasyon, tromboz.

Geçici Santral Venöz Kateterlerin Radyolojik Görüntüleme Yöntemleri Eşliğinde Uygulanmaları

Introduction: The temporary central venous catheters are used generally in patients who are going to go under bone marrow transplantation; in renal failure patients who need accute hemodiyalisis; in patients who need high volume exchange of blood like plasmaferesis and lokoferesis also in patients who have vassel problems. In this study we aimed to show our experiences in temporary central venous catheter placement under radiological imaging tecniques. Materials and Methods: Two hundred and eight patients who were placed temporary central venous catheters under local anesthesia with ultrasonography and floroscopy guidence in our clinique between the period January 2007 and November 2009 are detected retrospectively. Results: Two hundred and twenty eight temporary central venous catheters were placed to 208 patients. The most frequent localization of insertion was internal jugular vein (84.21%). Median catheter time was 20 day (total: 4240 catheter days; range: 4 to 34 catheter days). Complications occured in 14 patients. The most common complication was venous trombosis (2.6%). All the infectious complications were seen in the patients who are going to go under bone marrow transplantation (1.3%). Conclusion: Temporary central venous cateter placement with radiological imaging guidence which has short insertion time, high success and low complication rates is a safe and effective technique.

Keywords:

Central venous catheter, temporary, complication, trombosis,

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Oliver MJ. Acute dialysis catheters. Seminars in dialysis. 2001; 14:432-5.
Çil BE, Balkancı F. Hemodializ kateterleri. Hacettepe Tıp Der gisi 2004; 35:49-51
National kidney foundation-dialysis outcomes quality initiati- ve. İn: Schwab S, Besarab A, Beathard G, et al. (eds). NKF- DOQI Clin icat Practice Guidelines for Vascular Access. New York: National Kidney Foundation, 1997.
Atahan E, Yasim A, Cantimur AT. Hemodiyaliz hastalarında geçici kateter uygulamaları ve komplikasyonları. Erciyes Tıp Dergisi (Erciyes Medical Journal) 2006; 28:71-6.
Kidney DD, Nguyen DT, Deutsch LS. Radiologic evaiuation and management of malfunctioning long-term Central vein catheters. Am J Roentgenol 1998; 171:1251-7.
Cunrıingham RS, Ravikumar TS. A review of peripherally in- serted Central venous catheters in oncology patients. Surg Oncol Clin N Am 1995; 4:429-441.
Kalso E. A short history of Central venous catheterization. Açta Anaesth Scand 1985; 81:7-10.
Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973; 136:602-6.
Teichgraber UK, Gebauer B, Benter T, VVagner HJ. Central
venous access: radiological management of complications. Cardiovasc Intervent Radiol 2003; 26:321-33.
YilmazlarA, Bilgin H, Korfali G, Eren A, Okan U. Complicati ons of 1303 Central venous cannulations. J R Soc Med 1997; 90:319-21.
Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion çare: outco- mes analysis in 50470 patients. J Vasc tnterv Radiol 2002; 13:1009-16.
Kinney TB. İmaging guidance for Central venous access. İn: Ray CE Jr (ed). Central Venous Access. Philadelphia: Lippin- cott VVilliams & VVilkins, 2001; 19-48.
Parlak M, Sancak T, Arat M, Bilgiç S, Sanlidilek U. Tunneled catheters placed in bone marrow transplant patients: radiolo gical and clinical follow-up results. Diagn Interv Radiol 2006; 12:190-4.
Kock HJ, Pietsch M, Krause U, VVİlke H, EigierFVV. Implantab- le vascular Access systems: experience in 1500 patients with totaiiy implanted Central venous port systems. VVorld J Surg 1998;22:12-6.
Ballarini C, Intra N, Piani-Ceretti A, et al. Complications of subcutaneous infusion port in the general oncology populati on. Oncology 1999; 56:97-102.
Ahmad I, Ray CEJr. Complications of Central venous access devices. İn: Ray CE Jr. (ed). Central Venous Access. Phila delphia: Lippincott VVilliams & VVilkins, 2001:151-65.
Cimochowski CE, VVorley E, Rytherford VVE, et al. Superiority of internal jugular över subdavian access for temporary dialy sis. Nephron 1990:54:154-61.
Schillinger F, Schillinger D, Montagrac R, Milcent T. Central venous stenosis in hemodialysis:comparative angiographic study of subdavian and internal jugular access. Nephrologie 1994; 15:129-31.
Mcdonald S, VVattAJB, Edwards RD, Moss JG. Comparison of the internal jugular and subdavian venous routes in radio logical placed tunneled venous access lines. [Abstract] Cardi ovasc Intervent Radiol 1998; 21:81.
Kinney TB. İmaging guidance for Central venous access. İn: Ray CEJr. (ed). Central Venous Access. Philadelphia: Lippin cott VVilliams & VVilkins, 2001:19-48.
Arştan H, Erkoç R, Sakarya ME, Bozkurt M, Er R. Santral ve nöz kateterizasyonda renkli Doppler US rehberliğinin önemi. Tanı Girişim Radyol 1998; 4:275-2.
Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosi- us WT, Kneebone PH. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subciavi- an versus internal jugular venous access. Radiology 2000; 217:89-93.
DocktorBL, SadterDJ, Gray RR, Saliken JC, So CB. Radiolo- gic placement of tunneled Central catheters: rates of success and of immediate complications in a large series. Am J Roent- genol 1999; 173:457-60.
OguzkurtL, Tercan F, Torun D, et a l Impact of short-term he- modialysis catheters on the Central veins: a catheter venog- raphic study. Eur J Radiol 2004; 52:293-9.
Cassidy FP, Zajko AB, Bron KM, Reilly JJ, Peitzman AB, Ste- ed DL. Noninfectious complications o f long-term Central cat heters. Am J Roentgenol 1987; 149:671-5.
BrismarB, Hardstedt C, Jacobson S. Diagnosis of thrombosis by catheter phlebography after prolonged Central venous cat heterization. Ann Surg 1981; 194:779-83. 64