Author/Editor		Zver, S; Černelč, P
Title		Uporaba centralnega venskega katetra pri bolnikih z levkemijo
Translated title		The use of central venous catheter in patients with leukemia
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 64, št. 10
Publication year		1995
Volume		str. 569-72
Language		slo
Abstract		Background. Central venous catheter is for many years accompanist of intensive cytostatic treatment. In an article, we are dealing with experiences of six months, considering introduction of central venous catheters, nontunneled and tunneled ones. We noted down previous introductions of central venous catheters, complications, the number of thrombocytes, neutrophyl granulocytes and the number of the days catheter was in use. We introduced nontunneled catheters into the subclavian vein by medial infraclavicular approach and tunneled catheters into the internal jugular vein by low central approach. Results. We introduced 35 central venous catheters to 24 patients. Six times the insertions were not successful. Nontunneled catheter we introduced 27-times: 22-times into the subclavian vein, once into internal jugular vein and four times into femoral vein. We introduced also four tunneled catheters, two of them into internal jugular vein and two into subclavian vein. Among the serious immediate complications we had one hematopneumothorax (3.7 percent) and one pneumothorax (3.7 percent). After the insertion we noticed local inflammation arround catheter exit site in 21,8 percent and retrograde flow of the infusion fluid along the catheter in 12.9 percent. The average number of thrombocytes before the insertion of central venous line was 86.5 x 10 power 9/L. Six patients had the thrombocyte count below 20 x 10 power 9/L. Patients had tunneled catheter on average 110 days and nontunneled catheter for 39,8 days, the longest even for 150 days. Conclusions. When we are dealing with the introduction of the central venous line and patient with leukemia, we have to be especially aware of the thrombocytopenia and other coagulation disorders. Furthermore, we need to be careful about the prevention of the infection. In patient, where the central vein canniculation was difficult or not successful, we may expect serious complications as pneumothorax and bleeding.
Summary		Izhodišča. Centralni venski kateter je že vrsto let obvezen spremljevalec intenzivnega zdravljenja s citostatiki. V članku obravnavamo polletne izkušnje pri vstavljanju netuneliziranih in tuneliziranih centralnih venskih katetrov. Posebej smo bili pozorni na poprejšnja uvajanja centralnih venskih katetrov, na takojšnje in kasne zaplete, število trombocitov, nevtrofilnih granulocitov in na število dni uporabe katetra. netunelizirane katetre smo vstavljali v veno subklavijo z medialnimi infraklavikularnim pristopom, tunelizirane katetre pa v veno jugularis interno z nizkim centralnim pristopom. Rezultati. 24 bolnikom smo 35-krat ustavili centralni venski kateter. 6-krat je bilo uvajanje neuspešno. Netunelizirani kateter smo uvedli 27-krat: 22-krat v veno subklavijo, enkrat v veno jugularis interno in 4-krat v veno femoralis. Tunelizirani kateter smo uvedli 4-krat: 2-krat v veno jugularis interno in 2-krat v veno subklavijo. Zapleti ob vstavitvi so bili 1-krat hematopnevmotoraks (3,7 odstotka), 1-krat do pnevmothoraks (3,7 odstotka). Kasneje smo opažali vnetje kože in podkožja okoli izhodišča katetra (21,8 odstotka) in retrogradno zatekanje infuzijske tekočine ob katetru (12,9 odstotka). Povprečno število trombocitov ob vstavitvi CVK je bilo 86,5 x 10 na 9/L. Šest bolnikov je imelo število trombocitov pod 20 x 10 na 9/L. V povprečju so imeli bolniki vstavljen tunelizirani kateter 110 dni, netunelizirani kateter v veni subklaviji pa 39,8 dneva, najdlje celo 150 dni. Zaključki. Pri bolnikih z levkemijo velja pri uvajanju CVK posebna pozornost trombocitopeniji in drugim motnjam hemostaze, kasneje pa preprečevanju okužb zaradi nevtropenije. Če je bila vstavitev centralnega venskega katetra neuspešna ali težavna, lahko pogosto pričakujemo težje zaplete, kot sta pnevmothoraks in krvavitev.
Descriptors		LEUKEMIA CATHETERIZATION, CENTRAL VENOUS CATHETERS, INDWELLING SUBCLAVIAN VEIN JUGULAR VEINS