Осложнения при постановке и эксплуатации центральных венозных катетеров

Центральные венозные катетеры (ЦВК) широко используют у пациентов с рядом тяжелых заболеваний для проведения полного парентерального питания, химиотерапии, длительной антибиотикотерапии, гемодиализа, при лечении в отделениях интенсивной терапии, регулярных заборах крови для анализа. ЦВК значительно облегчают медикам ведение таких пациентов и улучшают качество их жизни, однако могут быть источником различных осложнений - венозных тромбозов, катетер-ассоциированных инфекций, повреждений прилежащих органов. В последние три десятилетия благодаря совершенствованию конструкции устройств венозного доступа и прогрессу в области визуализационных технологий значительно увеличилась частота успешных постановок ЦВК и снизилось количество связанных с ними осложнений. В обзоре освещены механизмы возникновения, клинические проявления, методы диагностики и лечения, а также способы предотвращения наиболее часто встречающихся и некоторых редких осложнений, которые могут возникать в процессе постановки и при эксплуатации ЦВК.

1. lanacci L., Piomelli S. Supportive care for children with cancer. Guidelines of the children's cancer study group. Use of venous access lines. Am J Pediatr Hematol Oncol 1984; 6: 227-81.

2. Sznajder J.I., Zveibil F.R., Bitterman H., Weiner P., Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146 (2): 259-61.

3. Сосудистый доступ в педиатрии: учеб. пособие / Под ред. В.В. Лазарева, М.В. Быкова, В.В. Щукина. - М.: ИндексМедМедиа, 2018. 264 с.

4. Peris A., Zagli G., Bonizzoli M., Cianchi G., Ciapetti M., Spina R., et al. Implantation of 3951 long-term central venous catheters: perfomances, risk analysis, and patient comfort after ultrasound-guidance introduction. Anesth Analg 2010; 111: 1194-201.

5. Bhutta S.T., Culp W.C. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol 2011; 14 (4): 217-24.

6. Kamphuisen P.W., Lee A.Y.Y. Catheter-related thrombosis: lifeline or a pain in the neck? Hematology Am Soc Hematol Educ Program 2012; 2012: 638-44.

7. Nayeemuddin M., Phervani A.D., Asquith J.R. Imaging and management of complications of central venous catheters. Clin Radiology 2013; 68 (5): 529-44.

8. National Institute for Health and Clinical Excellence. Central venous catheters - ultrasound locating devices (TA49). Available at: http://guidance.nice.org.uk/TA49 [accessed 01.04.12]

9. Randolph A.G., Cook D.J., Gonzales C.A., Pribble C.G. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996; 24: 2053-8.

10. Hind D., Caivert N., McWilliams R., Davidson A., Paisley S., Beverley C., et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 2003; 327: 361-7.

11. Tseng M., Sadler D., Wong J., Tea-que K.R., Schemmer D.C., Saliken J.C., et al. Radiological placement of central venous catheters: rates of success and immediate complications in 3412 cases. Can Assoc Radiol 2001; 52: 379-84.

12. Central Venous Catheters. Ed. by Hamilton H., Bodenham A.R. John Wiley & Sons, Ltd, 2009, 253 p.

13. Debourdeau P., Farqe D., Beckers M., Baqlin C., Bauersachs R.M., Brenner B., et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost 2013; 11 (1): 71-80.

14. Luciani A., Clement O., Halimi P., Gou-dot D., Portier F., Bassot V., et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001; 220: 655-60.

15. Di Carlo I., Pulvirenti E., Mannino M., Toro A. Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications. Ann Surg Oncol 2010; 17 (6): 1649-56.

16. Odendaal J., Kong V.Y., Sartorius B., Liu T.Y., Liu Y.Y., Clarke D.L. Mechanical complications of central venous catheterization in trauma patients. Ann R Coll Surg Engl 2017; 99 (5): 390-3.

17. Bowdle A. Vascular complications of central venous catheters placement: evidence-based methods for prevention and treatment. J Cardiothorac Vasc Anesth 2014; 28: 358-68.

18. Kusminsky R.E. Complications of central venous catheterization. J Am Coll Surg 2007; 204 (4): 681-96.

19. Vats H.S. Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis 2012; 19: 188-94.

20. Kornbau C., Lee K.C., Hughes G.D., Firstenberg M.S. Central line complications. Int J Crit Illn Sci 2015; 5 (3): 170-8.

21. Heckmann J.G., Lang C.J., Kindler K., Huk W., Erbguth F.J., Neundorfer B. Neurologic manifestations of cerebral air embolism as a complication of central venous catheterization. Crit Care Med 2000; 28: 1621-5.

22. Fearon P.V., Roy D., McGarry G.W. An unusual iatrogenic vocal cord paralysis. CME Bull Otorhinolaryngol Head Neck Surg 2001; 5: 20-1.

23. Wang L., Liu Z.S., Wang C.A. Malposition of central venous catheter: presentation and management. Chin Med J (Engl) 2016; 129 (2): 227-34.

24. Gibson F., Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth 2013; 110: 333-46.

25. Сердечно-сосудистая хирургия: руководство /Под ред. В.И. Бураковского, Л.А. Бокерия. - М.: Медицина, 1989, 752 с.

26. Kawashima T., Sato K., Sato F., Sasaki H. An anatomical study of human cardiac veins with special reference to the drainage of the great cardiac vein. Ann Anat 2003; 185: 535-42.

27. Forauer A.R., Theoharis C.G.A., Dasika N.L. Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model. Radiology 2006; 12: 427-34.

28. Xiang D.Z., Verbeken E..K., Van Lom-mel A.T., Stas M., De Wever I. Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg 1998; 28 (2): 260-71.

29. Krausz D.J., Fisher J.S., Rosen G., Haramati L.B., Jain V.R., Burton W.B. Retained fibrin sheaths: chest computed tomography findings and clinical associations. J Thorac Imaging 2014; 29 (2): 118-224.

30. Bessoud B., de Baere T., Kuoch Y., Desruennes E., Cosset M.F., Lassau N., et al. Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in paediatric and adult patients. Am J Roentgenol 2003; 180: 527-32.

31. Kerner J.A.Jr., Garcia-Careaga M.G., Fisher A.A., Poole R.L. Treatment of catheter occlusion in pediatric patients. JPEN J Parenter Enteral Nutr 2006; 30 (1): S73-81.

32. Rihn T. Fibrinolytic therapy in central venous catheter occlusion. J Intravenous Nurs 2001; 34 (3S): S9-12.

33. Gray R.J., Levitin A., Buck D., Brown L.C., Sparling Y.H., Jablonski K.A., et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters. J Vasc Interv Radiol 2000; 11: 1121-9.

34. Kreuziger L.B., Jaffray J., Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Research 2017; 157: 64-71.

35. Verso M., Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21: 3665-75.

36. Chopra V., Anand S., Hickner A., Buist M., Rogers M.A., Saint S., et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013; 382 (9889); 311-25.

37. Di Nisio M., Van Sluis G.L., Bossuyt P.M., Buller H.R., Porreca E., Rutjes A.W. Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review. J Thromb Haemost 2010; 8 (4): 684-92.

38. Bates S.M., Jaeschke R., Stevens S.M., Goodacre S., Wells P.S., Stevenson M.D., et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 9th ed. Chest 2012; 141 (Suppl 2): e351S-418S.

39. Kearon C., Akl E.A., Comerota A.J., Prandoni P., Bounameaux H., Goldhaber S.Z., et al. Antitrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis. American College of Chest Physicians Evidence- 47. Based Clinical Practice Guidelines. 9th ed. Chest 2012; 141 (suppl. 2): e419S-e494S.

40. Mitchell M.D., Anderson B.J., Williams K., Umscheid C.A. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. J Adv Nurs 2009; 65: 2007-21.

41. Raad I., Hanna H. Nosocomial infections related to use of intravascular devices inserted for long term vascular access. 49. In: Mayhall C., editor. Hospital epidemiology and infection control. Philadelphia: Lippincott Williams & Wilkins; 1999, p. 165-72.

42. Maki D.G., Kluger D.M., Crnich C.J. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proc 2006; 81: 1159-71.

43. Agarwal A.K. Central vein stenosis: current concepts. Adv Chronic Kidney Dis 2009; 16: 360-70.

44. MacRae J.M., Ahmed A., Johnson N., Levin A., Kiaii M. Central vein stenosis: a common problem in patients on hemodialysis. ASAIO J 2005; 51: 77-81.

45. Smit J.M., Raadsen R., Blans M.J., Petjak M., Van de Ven P.M., Tuinman P.R. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care 2018; 22 (1): 65.

46. Lyon S.M., Giren M., Marshall N.L. Interventional radiology in the provision and maintenance of long-term central venous access. J Med Imaging Radiat Oncol 2008; 52: 10-7.

47. Mirza B., Vanek V.W., Kupensky D.T. Pinch-off syndrome: case report and collective review of the literature. Am Surg 2004; 70: 635-44.

48. Surov A., Wienke A., Carter J.M., Stoevesandt D., Behrmann C., Spiel-mann R.P., et al. Intravascular embolization of venous catheter - causes, clinical signs and management: a systemic review. J Parenter Enteral Nutr 2009; 33: 677-85.

49. Chan B.K., Rupasinghe S.N., Hennessey I., Peart I., Baillie C.T. Retained central venous lines (CVLs) after attempted removal: an 11-year series and literature review. J Pediatr Surg 2013; 48 (9): 1887-91.