Mehmet MUTLU, Şebnem KADER, Yakup ASLAN, Burcu Küçükalioğlu PARILTAN, İlker EYÜPOĞLU, Filiz Acar AKTÜRK

Göbek veni kateteri yerleştirmede kullanılan yöntem ve formüllerin karşılaştırılması

Amaç: Ciddi hastalığı bulunan yenidoğanlarda santral venöz yol sıklıkla göbek venine kateter takılarak sağlanır. Bu çalışmada; göbek venine kateter takılan hastalarda, göbek kateterinin göbek veni içerisinde ne kadar ilerletilmesi gerektiğini belirlemede sıkça kullanılan yöntem ve formüllerin (Dunn yöntemi, Shukla-Ferrara ve Değiştirilmiş ShuklaFerrara formülü) birbirleri ile karşılaştırılarak en uygun yerleşimin hangisi ile sağlandığını saptamak amaçlanmıştır.Gereç ve Yöntemler: Bu gözlemsel, ileriye dönük çalışmaya, 41'i Dunn yöntemi (grup 1), 40'ı Shukla-Ferrara (grup 2) ve 40'ı Değiştirilmiş Shukla-Ferrara (grup 3) formülüne göre göbek venine kateter takılan toplam 121 olgu alındı. Kateter takıldıktan sonra kateterin uç noktası, ön-arka göğüs filmi ile belirlendi. Vertebral kolon boyunca ilerleyen kateterlerden ucu dokuzuncu ve 10. torasik vertebra arasında olanlar uygun yerleşimli, dokuzuncu torasik vertebranın üzerinde olanlar yüksek yerleşimli ve 10. torasik vertebranın altında olanlar alçak yerleşimli olarak kabul edildi. Yüksek, alçak ve uygun yerleşimli kataterlerin gruplara göre dağılımı ve izlemde oluşan komplikasyonlar kaydedildi.Bulgular: Uygun kateter yerleşimi; Shukla-Ferrara formülüne göre takılanlarda %53 (17/32), Değiştirilmiş Shukla-Ferrara formülüne göre takılanlarda %40 (12/30), Dunn yöntemine göre takılanlarda ise %38 (11/29) idi ve gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Komplikasyon olarak bir hastada trombüs ve bir hastada kateter ilişkili kan dolaşımı enfeksiyonu saptandı.Çıkarımlar: Shukla-Ferrara formülüne göre kateter takılanlarda, uygun yerleşim oranı daha yüksek bulunmakla birlikte, istatistiksel anlamlılık saptanmamıştır. Daha geniş serilerin incelendiği çalışmalara gereksinim vardır.

Comparison of methods and formulas used in umbilical venous catheter placement

Aim: Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters.Material and Methods: This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra and too low if the tip was below the 10th thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. Results: In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other.Conclusions: This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic.

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