Şenol GÜLMEN, İlker KİRİŞ, Ahmet ÖCAL, Aytuğ KOÇYİĞİT, Oktay PEKER, Erkan KURALAY, Hüseyin OKUTAN

Açık kalp cerrahisinde santral venöz kateterizasyon: İnternal juguler ven ya da supraklaviküler subklaviyen ven yaklaşım?

Amaç: Bu çalışmada santral venöz kateter (SVK) takılan hastalarda komplikasyon gelişimine etki eden faktörler araştırıldı.Çalışma planı: Kasım 2007 - Ocak 2009 tarihleri arasında kliniğimizde SVK uygulanan 94 hasta (69 erkek, 25 kadın; ort. yaş 60.3±13.2 yıl; dağılım 4-84 yıl) ileriye yönelik olarak incelendi. Hastalar rastgele iki gruba ayrıldı. Santral venöz kateter grup 1'de (n=49), sağ internal juguler ven (İJV) yoluyla, grup 2'de (n=45) ise sağ supraklaviküler subklaviyen ven (SpSV) yoluyla uygulandı. Tüm SVK'ler aynı hekim tarafından Seldinger tekniği ile takıldı.Bulgular: Demografik özellikler açısından iki grup arasında anlamlı fark yoktu. Ameliyat sırası ve sonrası dönemde, iki grup arasında pnömotoraks, hemotoraks, malpozisyon, hematom gelişimi, nörolojik hasar, infeksiyon ve kateter kalış süresi açısından anlamlı fark bulunmadı. Dokuz hastada arter ponksiyonu [grup 1 (n=8) ve grup 2 (n=1); p=0.020], yedi hastada pinch-off fenomeni [grup 1 (n=0) ve grup 2 (n=7); p=0.004] ve 19 hastada iki veya daha fazla girişim [grup 1 (n=16) ve grup 2 (n=3); p=0.002] gerçekleşti. Çokdeğişkenli analizde; arter ponksiyonu için vücut kütle indeksi (VKİ) (p=0.028), pinch-off fenomeni için VKİ (p=0.040) ve SpSV yaklaşım (p=0.022); iki veya daha fazla girişim için ise İJV yaklaşım (p=0.007) güçlü öngörücü faktörler olarak saptandı.Sonuç: Başarılı bir girişim için hasta anatomisi, VKİ ve hekimin deneyimi göz önünde bulundurulmalı ve bu seçenekler arasında SpSV kateterizasyonunun da olabileceği düşünülmelidir

Central venous catheterization in open heart surgery: internal jugular vein or supraclavicular subclavian vein approach?

Background: In this study we investigated the factors that affect the development of complications in patients who had central venous catheter (CVC) insertion.Methods: Ninety-four patients (69 males, 25 females; mean age 60.3±13.2 years; range 4 to 84 years) who had CVC between November 2007 - January 2009 in our clinic were investigated prospectively. Patients were randomized to two groups; in group 1 (n=49), CVC was performed through right internal jugular vein (IJV), and in group 2 (n=45), CVC was performed through right supraclavicular subclavian vein (SpSV). All of the CVC's were performed by means of Seldinger's technique by the same operator.Results: There were no significant differences in the demographic features between the two groups. There were no significant differences between the groups with regard to pneumothorax, hemothorax, malposition, hematoma development, neurological damage, infection and catheter stay in the intra- and postoperative periods. Nine cases had arterial puncture [group 1 (n=8) and group 2 (n=1); p=0.020], seven cases had pinch-off phenomenon [group 1 (n=0) and group 2 (n=7); p=0.004], and 19 cases had two or more interventions [group 1 (n=16) and group 2 (n=3); p=0.002]. In the multivariate analysis, the powerful predictive factor for arterial puncture was the body mass index (BMI) (p=0.028), for the pinch-off phenomenon BMI (p=0.040) and the SpSV approach (p=0.022); the predictive factor for two or more insertional attempts was IJV approach (p=0.007).Conclusion: The patient's anatomy, BMI and the physician's experience should be considered for a successful attempt. We think that SpSV catheterization may be among the preferences.

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