植入式静脉港导管断裂原因分析及预防措施
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摘要
目的探讨经颈内静脉途径植入静脉港导管发生断裂的原因及高危因素,指导临床合理安全使用静脉港。方法通过随访和应用医院PACS网络回顾性分析2013年11月至2016年3月河北医科大学第四医院3102例乳腺癌静脉港植入患者,归纳其临床资料及影像学表现,针对患者年龄、职业、生活习惯、置入静脉港时间、部位、导管头端位置、血管腔内外导管夹角等观察指标,对静脉港导管断裂相关因素进行统计学分析。结果 3102例患者共发生静脉港导管断裂15例(0.48%),12例患者断裂部位位于颈内静脉入口处,2例患者发生于静脉港出口处,1例位于导管头端位置。导管断裂与置入静脉港时间、职业、年龄及生活习惯等因素密切相关,而与置入静脉港位置、导管头端位置、血管内外导管夹角等因素无关。结论经颈内静脉穿刺静脉港植入是一种安全、有效、且并发症较少的方法,明确静脉港导管断裂相关因素并早期预防可提高其安全性。
Objective To investigate the risk factors of the fracture of the implantable vascular access devices which can give us instructions to utility vascular access devices safely. Methods 3102 cases of patients with vascular access devices were retrospectively analyzed from November 2013 to March 2016 in the 4 th hospital of Hebei Medical University.We summarized the clinical and radiographic data( age,occupation,living habit,port time,port location,the location of the catheter head and the angle between the inner and outer catheter) to analyze the related factors of fracture in 3102 patients.Results 15 cases were detected fracture in all patients,and the fracture site were located at the entrance of the internal jugular vein( n = 12),the outlet of the vascular access devices( n = 1),the end of the catheter( n = 2). Fracture was closely related to the factors of port time,age and occupation,but not related to the location of the port,the position of the head of the catheter and the angle of the inner and outer catheter. Conclusion Implantable vascular access devices were approved by its advantages of safety,effectiveness and less invasion. It is important to clarify the related factors and early prevention of fracture.
Objective To investigate the risk factors of the fracture of the implantable vascular access devices which can give us instructions to utility vascular access devices safely. Methods 3102 cases of patients with vascular access devices were retrospectively analyzed from November 2013 to March 2016 in the 4 th hospital of Hebei Medical University.We summarized the clinical and radiographic data( age,occupation,living habit,port time,port location,the location of the catheter head and the angle between the inner and outer catheter) to analyze the related factors of fracture in 3102 patients.Results 15 cases were detected fracture in all patients,and the fracture site were located at the entrance of the internal jugular vein( n = 12),the outlet of the vascular access devices( n = 1),the end of the catheter( n = 2). Fracture was closely related to the factors of port time,age and occupation,but not related to the location of the port,the position of the head of the catheter and the angle of the inner and outer catheter. Conclusion Implantable vascular access devices were approved by its advantages of safety,effectiveness and less invasion. It is important to clarify the related factors and early prevention of fracture.
引文
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10周涛,唐甜甜,李云涛,等.植入式静脉输液港两种不同植入方式对比研究(附2897例分析)[J].中国实用外科杂志,2015,35:753-755.
2王建新,唐甜甜,谢艳丽,等.植入式静脉输液港常见并发症的临床分析[J].护士进修杂志,2012,27:958-960.
3陈丽莉,何惠燕,毛晓群.乳腺癌患者应用植入式中心静脉输液港的常见问题与对策[J].中华护理杂志,2011,46:1116-1117.
4刘学强,郭平凡,张金池,等.15例医源性血管内异物的取出经验[J].中国介入影像与治疗学,2012,9:508-511.
5尹礼娟.输液港导管断裂的原因分析及对策[J].江苏医药,2015,41:2909-2910.
6武中林,李智岗,李顺宗,等.植入式静脉输液港体内导管断裂介入捕捞的临床应用价值[J].临床放射学杂志,2015,34:271-275.
7 Lin CH,Wu HS,Chan DC,et al.The mechanisms of failure of totally implantable central venous access system:analysis of 73 cases with fracture of catheter[J].Eur J Surg Oncol,2010,36:100-403.
8 Surov A,Wienke A,Garter JM,et al.Intravascular embolization of venouns catheters auses,clinical signs,and management:a systematic review[J].J Parenter Enteral Nutr,2009,33:677-685.
9 Aitkcn DR,Minton JP.The"pinch-off sign";a warning of impending problems with permanent subclavian catheters[J].Am J Surg,1984,148:633-636.
10周涛,唐甜甜,李云涛,等.植入式静脉输液港两种不同植入方式对比研究(附2897例分析)[J].中国实用外科杂志,2015,35:753-755.