Résumé
Objective To investigate the success rate of fluoroscopy-guided subclavian vein catheter implantation (SVCI) in children with hematologic diseases,to improve the visualization of the position of the catheter head,and to reduce the incidence of procedure-related complications.Methods Fluoroscopyguided SVCI was performed in 183 sick children (aged 1-16 years) with confirmed hematologic disease.The success rate of the catheter implantation,the number of needle puncturing,the operation time,the fluoroscopy time and the occurrence of procedure-related complications were recorded.Results Successful fluoroscopy-guided SVCI was accomplished in all 183 sick children,with a success rate being 100％.Successful SVCI was obtained with ＜3 times of puncturing in 151 sick children (82.5％),with 4-6 times of puncturing in 25 sick children,and with 7-10 times of puncturing in 7 sick children.The catheter tip was successfully positioned at the junction of the superior vena cava with the right atrium in all sick children.The operation time ranged from 5 min to 25 min with a mean of (10.38±4.04) min.The fluoroscopy time varied from 16 seconds to 607 seconds with a mean of (65.46±55.86) seconds.During the procedure,artery was wrongly punctured two times in two sick children.The mean follow-up time was 35 days.Cather-related infection occurred in 2 sick children.No local hematoma at puncture point,nor hemopneumothorax or catheter-related thrombosis occurred.Conclusion Fluoroscopy-guided SVCI has high technical success rate in children with hematologic diseases.For a successful procedure of SVCI,less number of needle puncturing is needed by using this technique.The satisfaction rate for the placement of catheter tip is high and the incidence of complications is low.Therefore,fluoroscopy-guided SVCI is a safe and effective method.
Résumé
Objective To analyze the risk factors of subclavian venous catheter-related infections in patients with traumatic hemorrhagic shock (THS) and provide a basis for prevention and control of the infection. Methods A retrospective study was conducted. 357 patients with THS and indwelling of subclavian vein catheter admitted in the Department of Emergency of Affiliated Hospital of Sichuan Provincial Luzhou Medical College were enrolled, and according to the infection state, they were divided into infection group (56 cases) and non-infection group (301 cases). The patients' data of gender, age, history of underlying disease, catheter position, catheter indwelling time, time staying in hospital, situation of antimicrobial drug used, application of tracheotomy or not, white blood cell count (WBC) levels, etc were collected for univariate analysis. The resulting indexes with statistical significance were applied for carrying out the multivariate logistic regression analysis, and then the independent risk factors involved in the development of subclavian venous catheter-related infections in the shock patients could be screened out.Results In 357 patients with THS, 56 were infected (15.7%). Univariate analysis showed: age ≥ 60 years (χ2 = 19.839,P < 0.001), with diabetes mellitus in past history (χ2 = 6.252,P = 0.012), catheter indwelling time ≥ 7 days (χ2 = 19.261,P < 0.001), time staying in hospital ≥ 7 days (χ2 = 4.315,P = 0.038), time for use of antimicrobial drug≥ 7 days (χ2 = 16.161,P < 0.001), tracheotomy (χ2 = 40.969,P < 0.001), WBC < 4×109/L (χ2 = 39.451,P < 0.001) and the disease severity grade 4 - 5 (χ2 = 8.345,P = 0.004) were the risk factors of subclavian venous catheter-related infections in patients with THS. Multivariate analysis showed: catheter indwelling time ≥ 7 day [odds ratio (OR) = 16.713, 95% confidence interval (95%CI) 3.651 - 76.624), tracheotomy (OR = 6.861, 95%CI 2.377 - 18.246), WBC < 4×109/L (OR = 4.903, 95%CI 1.887 - 12.643) were the independent risk factors of subclavian venous catheter-related infections in THS patients.Conclusion The strict implementation of aseptic catheterization, shortening the time of catheter indwelling as much as possible and the rational use of antibiotics can effectively reduce and prevent the incidence of venous catheter-related infection in THS patients.
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Objective To investigate the causes and preventive measures of subclavian venous catheter-related infections oc-curred in traumatic hemorrhagic shock patients .Methods 336 traumatic hemorrhagic shock patients indwelling subclavian vein catheter was included to explore the causes and treatment of catheter-related infections .The outcome was infect rate and strains dis-trubtion .Results Of 336 patients with subclavian vein catheterization average time was 4 .3 days ,including 27 cases of infection , and the infection rate was 8 .04% .All patients were discharged after active treatment ,with no deaths .Conclusion Traumatic hem-orrhagic shock patients with subclavian vein catheter are safe and effective .Risk factors for infection ,improve treatment and patient care ,shorten the time of catheter ,can effectively prevent catheter infections .
Résumé
Wolff-Parkinson-White (WPW) syndrome is characterized by classical electrocardiographic findings resulting from preexcitation of a part of the ventricular myocardium due to anomalous atrioventricular conduction via a accessory pathway. Anesthetic management with this syndrome is aimed at avoiding tachycardia and cardiac arrhythmia by using the techniques to avoid hypoxia, hypercarbia, acidosis and sympathetic stimulation. We experienced a case of severe hypotension and paroxysmal supraventricular tachycardia (PSVT) during insertion of subclavian vein catheter on a patient with this syndrome prior to operation, in spite of adequate anesthetic management. The patient's condition was recovered after infusion of adenosine and removal of catheter. Operation was postponed for further evaluation of WPW syndrome. After 3 days, electrophysiologic study was done and accessory pathway was ablated by radiofrequency catheter. After 6 days, the patient was operated uneventfully and discharged 2 weeks later. We report that minor stimulation such as central venous catheterization on a patient with WPW syndrome can cause life-threatening severe hypotension and PSVT.