Yalım DİKMEN, Seval ÜRKMEZ, Oktay DEMİRKIRAN, Tuğhan UTKU

Santral ven kateterizasyonunun mekanik komplikasyonları

Amacı, yoğun bakım hastası olmayan hasta grubunda santral ven kateterizasyonu (SVK) sırasında oluşan mekanik komplikasyonların retrospektif olarak incelenmesi olan çalışmada 516 hasta irdelenmiştir. Oniki aylık süreçte 516 kateter girişimi olup 514 kateter başarı ile takıldı (başarı oranı % 99.61). Toplam 21 komplikasyon (% 4.067) saptanmış olup komplikasyon dağılımları; arter ponksiyonu 10 adet, kateter ven yerleşim hatası 6 adet, pnömotoraks 3 adet, başarısız girişim 2 adet. Komplikasyon görülme sıklığı üçüncü yıl uzmanlık öğrencisi hekim grubunda en yüksek, birinci yıl hekim grubundu en düşük olarak saptandı. Sonuç; SVK uygun ortamlarda ve deneyimli doktorlar tarafından uygulandığında güvenli bir işlemdir.

Mechanical complications of central venous catheterization

The aim of this study was evaluate to the mechanical complications of central venous catheterization (CVC) in non-lCU patients. Over a 12-month period, 516 attempts catheterization were evaluated retrospectively. There were 514 lines inserted (success rate, 99.61 %), overall 21 complications had occured (4.067 %); which included 10 arterial punctures, 6 malposition of catheter tip, 3 pneumothoraces and 2 failed catheterization attempts. Most of the complications had been seen in thirth year residents while least of them were seen in first year residents. In conclusion, CVC is a relatively safe practice when applied by experienced medical doctors and in a controlled setting.

PDF

___

1. Varvinski AM, Findlay GP: Immediate complications of central venous cannulation in ICU. Critical Care 2000; 4(Suppl):1, P6.
2. Rippe JM, Irwin RS, editors: Procedures and Techniques in Intensive Care Medicine. Boston:Little, Brown and Company; 1995; p.15-36.
3. Abraham E, Shapiro M, Podolsky S: Central venous catheterization in the emergency setting. Crit Care Med 1983; 11(2):515-7.
4. Arrighi AA, Farnell MB, Mucha D: Prospective randomized trial of rapid venous access for patients in hypovolemic shock. Ann Emerg Med 1989; 18:927-30.
5. Broadwater JR, Henderson MA, Bell JL, Edwards MJ, Smith GJ, McCready DR, Swanson RS, Hardy ME, Shenk RR, Lawson M: Outpatient percutaneous central venous access in cancer patients. Am J Surg 1990; 160(6):676-80.
6. Gladwin MT, Slonim A, Landucci DL, Gutierrez DC, Cunnion RE: Cannulation of the internal jugular vein: Is postprocedural chest radiography always necessary? Crit Care Med 1999; 27(9):1819-23.
7. Yılmazlar A, Bilgin H, Korfalı G, Eren A, Özkan U: Comp-lications of 1303 central venous cannulations. J R Soc Med 1997; 90(6):319-21.
8. Hagley MT, Martin B, Gast P, Traeger SM: Infectious and mechanical complications of central venous catheters placed by percutaneous venipuncture and over guidewires. Crit Care Med 1992; 20(10):1426-30.
9. Savage AP, Picard M, Hopkins CC, Malt RA: Complica-tions and survival of multilumen central venous catheters used for total parenteral nutrition. Br J Surg 1993; 80:1287-90.
10. Cook D, Randolph A, Kernerman S, Cupido C, King D, Math B, Soukup C, Buisson CB: Central venous catheter replacement strategies: a systematic review of literature. Crit Care Med 1997; 25(8):1417-24.