摘要
目的描述1例应用单环网篮导丝成功取出脱落至股静脉的导丝的病例。回顾既往文献报道,针对导丝脱入深静脉的原因、检查方法以及取出的方法做一回顾,为减少Seldinger技术相关的并发症提供建议。病例介绍患者男性,71岁。应用Seldinger技术经右股静脉穿刺放置血滤管过程中不慎将导丝脱落至股静脉。外科尝试经右股静脉切开取导丝未成功。后经左侧股静脉穿刺,置入9 F鞘管,并经由6 F JR3.5导引导管送入单环网篮导丝,成功取出脱落至对侧股静脉的导丝。文献检索及分析检索Pubmed、中国知网、万方数据库。检索的英文关键词包括:"missed""retained""guide wire""central venous catheterization""complications"及"Seldinger wire",检索的中文关键词包括"脱落""遗留""导引导丝""深静脉置管""并发症"及"Seldinger导丝"。检索年限截止至2017年11月30日。共检出符合标准的文献127篇,经进一步筛选标题及摘要获得关于深静脉残留导丝的病例报告及系统回顾共21篇。结论经皮深静脉置管过程中导丝脱落并不少见,这是一个有潜在生命危险的并发症。它往往与操作者经验不足、对此类并发症警惕性不够,以及缺乏监督管理有关;或因为繁重的工作强度、人力不足及夜班操作等造成医务人员疲劳工作所导致。
Objective To describe the successful removal of a wire missed in right femoral vein by a basket net wire,we reviewed published reports to analyze the risk factors for missed wire,the method for detection and retrieval.So we can give some suggestions to improve safety of Seldinger technique.Clinical Feature A 71-year-old male patient suffered from a missed wire in right femoral vein.The surgeon failed to retrieve it by incising the right femoral vein.We placed a 9‑French introducer sheath in left femoral vein,and advanced a 6 F Judkins right 3.5 catheter.Finally,the missed wire was removed successfully by a basket net wire.Data Review We reviewed literature from Pubmed,CNKI and WANFANG Data with keywords of“missed”,“retained”,“guide wire”,“central venous catheterization”,“complications”and“Seldinger wire”.There were 127 pulications till November 30,2017.OF these,21 cases were further selected.Conclusions Missed wire during central venous catheterization is not uncommon,which is a potentially life-threatening complication.The risk factors for it include insufficient experience,lack of alertness for such complications,heavy work intensity,and inadvertency of supervision and management.
作者
杨敏
刘晨曦
高爽
唐熠达
YangMin;Liu Chenxi;Gao Shuang;Tang Yida(Department of Cardiology,Fuwai Hospital affiliated to Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Cardiac Surgery,Fuwai Hospital affiliated to Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Beijing 100037,China)
基金
中国医学科学院院所青年基金(2015-F03)
北京市科学技术委员会(20181100006318005)。
关键词
穿刺术
导管插入术
中心静脉
手术中并发症
Punctures
Catheterization,central venous
Intraoperative complications
