Ufuk Turan Kürşat KORKMAZ, Erhan Renan UÇAROĞLU

Santral Venöz Kateterizasyonun Önemli Bir Komplikasyonu Olarak Kateter Malpozisyonu: Üçüncü Basamak Sevk Hastanesinde 23 Olgunun Analizi

Amaç: Bu çalışmada santral venöz kateterizasyon sonrası kateter malpozisyonu olan hastaların klinik özelliklerini sunmayı ve ilgili literatürü gözden geçirmeyi amaçladık. Gereç ve Yöntem: Ocak 2011 - Aralık 2018 tarihleri arasında üçüncü basamak bir sevk hastanesinde internal juguler veya subklavyen ven yoluyla santral venöz kateterizasyon uygulanan toplam 1816 hasta bu kesitsel çalışmada değerlendirildi. Bunlardan 23 olguda işleme bağlı kateter malpozisyonu tespit edildi ve çalışma popülasyonu kateter malpozisyonu olan bu olgulardan oluşturuldu. Çalışma popülasyonunun tıbbi verileri elde edildi ve geriye dönük olarak incelendi. Bulgular: Santral venöz kateterizasyon sonrası kateter malpozisyon oranı %1,26 idi. Çalışma popülasyonunun ortalama yaşı 55,1±21,3 yıl idi ve %52,2’si erkekti. Olguların 21’inde (%91,3) seçilen yaklaşım ultrason rehberliği olmaksızın kör nokta tekniği idi. Çalışma popülasyonunda, prosedüre bağlı diğer komplikasyonlar sırasıyla altı, üç ve iki olguda gözlenen subkütan hematom, pnömotoraks ve hemopnömotoraks idi. İşlemle ilişkili komplikasyonlar dışındaki nedenlere bağlı hastanede ölüm iki olguda görüldü. Sonuç: Kateter malpozisyonu, nispeten daha az karşılaşılan ancak santral venöz kateterizasyonun önemli bir komplikasyonudur. Santral venöz kateterizasyon sırasında, kateter malpozisyon riskini en aza indirgemek için kör nokta tekniği yerine radyolojik kılavuzlu yaklaşımın tercih edilmesi gerektiğini düşünüyoruz.

Catheter Malposition as a Considerable Complication of Central Venous Catheterization: An Analysis of 23 Cases in a Tertiary Referral Hospital

Objectives: We aimed to present the clinical characteristics of patients with catheter malposition following central venous catheterization, and to review the relevant literature. Materials and Methods: A total of 1816 patients who underwent central venous catheterization via internal jugular or subclavian vein in a tertiary referral hospital between January 2011 and December 2018 were researched for this cross-sectional study. Among them, procedure-related catheter malposition was detected in 23 cases, and the study population composed of these cases with catheter malposition. Medical data of study population were obtained and retrospectively reviewed. Results: The rate of catheter malposition following central venous catheterization was 1.26%. The mean age of the study population was 55.1±21.3 years, and 52.2% of them were male. The blind-landmark technique without ultrasound guidance was the selected approach in 21 of cases (91.3%). In study population, additional procedure-related complications were subcutaneous hematoma, pneumothorax, and hemo-pneumothorax in six, three and two cases, respectively. In-hospital death was observed in two cases because of the causes other than procedure-related complications. Conclusion: Catheter malposition is a relatively lesser encountered but an important complication of central venous catheterization. We suggest that during central venous catheterization, the radiological-guided approach should be of choice instead of the blind-landmark technique to minimize the risk of catheter malposition.

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