PDF(Pubmed)
Abstract：
Centrally inserted central catheters (CICCs) are indispensable in modern healthcare, but unfortunately, come with complications. Catheter-related thrombosis is a well-known complication reported to occur in 5-30% of patients with CICC. There is a paucity of studies that report the incidence of catheter-related thrombosis after the introduction of real-time ultrasound insertion guidance as clinical practice. This study aimed to demonstrate any pathological macro- or microscopic changes in the vein wall associated with CICCs.
The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to autopsies. Vessels with inserted catheters were macroscopically and microscopically examined.
In total, seven female and five male patients with a median age of 70 (interquartile range 63-76) were included. With one exception, all patients received routine thromboprophylaxis throughout the period with CICC. Most inserted CICCs were 9.5 French (54%) and were inserted in the internal jugular vein (92%). The median time with CICC was seven days (interquartile range 1.8-20). At autopsy, thrombi were observed in all cases (100%), macroscopically and microscopically, attached to the distal portion of the CICC and/or the adjacent vessel wall. Inflammatory changes in the vessel walls were seen in all cases, and varying degrees of fibrosis were demonstrated in eight cases (67%).
This autopsy study demonstrated that catheter-related thrombus formation with adjacent inflammatory and fibrotic vessel wall thickening was very common, despite a limited period of catheter use. The consequences of these findings are important, as thrombi may cause pulmonary embolism and possibly lead to catheter-related infections, and since inflammatory and fibrotic vessel wall thickening may evolve into chronic venous stenosis. Furthermore, the findings are a cause of concern, as CICCs are indispensable in modern healthcare and complications may be masked by the general disease that was the indication for CICC insertion.
The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to autopsies. Vessels with inserted catheters were macroscopically and microscopically examined.
In total, seven female and five male patients with a median age of 70 (interquartile range 63-76) were included. With one exception, all patients received routine thromboprophylaxis throughout the period with CICC. Most inserted CICCs were 9.5 French (54%) and were inserted in the internal jugular vein (92%). The median time with CICC was seven days (interquartile range 1.8-20). At autopsy, thrombi were observed in all cases (100%), macroscopically and microscopically, attached to the distal portion of the CICC and/or the adjacent vessel wall. Inflammatory changes in the vessel walls were seen in all cases, and varying degrees of fibrosis were demonstrated in eight cases (67%).
This autopsy study demonstrated that catheter-related thrombus formation with adjacent inflammatory and fibrotic vessel wall thickening was very common, despite a limited period of catheter use. The consequences of these findings are important, as thrombi may cause pulmonary embolism and possibly lead to catheter-related infections, and since inflammatory and fibrotic vessel wall thickening may evolve into chronic venous stenosis. Furthermore, the findings are a cause of concern, as CICCs are indispensable in modern healthcare and complications may be masked by the general disease that was the indication for CICC insertion.
摘要：
背景：中央插入的中央导管（CICC）在现代医疗保健中是必不可少的，但不幸的是,伴随着并发症。导管相关血栓形成是一种众所周知的并发症，据报道在5-30％的CICC患者中发生。很少有研究报告在引入实时超声插入引导作为临床实践后导管相关血栓形成的发生率。这项研究旨在证明与CICC相关的静脉壁的任何病理宏观或微观变化。
方法：该研究获得了瑞典伦理审查机构的批准，并在一家大型大学医院进行。该研究包括12例接受尸检的短期MCI患者。对插入导管的血管进行宏观和微观检查。
结果：总计，包括7例女性患者和5例男性患者,中位年龄为70岁(四分位距63~76岁).除了一个例外,所有患者在CICC期间接受常规血栓预防.大多数insertedCICC为9.5French（54％），并插入颈内静脉（92％）。CICC的中位时间为7天（四分位距1.8-20）。尸检时,在所有病例中均观察到血栓（100%），宏观和微观，连接到CICC的远端部分和/或相邻的血管壁。在所有病例中均可见血管壁中的炎症变化，8例(67%)出现不同程度的纤维化。
结论：这项尸检研究表明，导管相关的血栓形成与邻近的炎症和纤维化血管壁增厚非常普遍，尽管导管使用时间有限。这些发现的后果很重要，因为血栓可能导致肺栓塞，并可能导致导管相关感染，并且由于炎性和纤维化血管壁增厚可能演变成慢性静脉狭窄。此外，这些发现令人担忧，asCICC在现代医疗保健中是不可或缺的,并发症可能被作为CICC插入指征的一般疾病所掩盖.
方法：该研究获得了瑞典伦理审查机构的批准，并在一家大型大学医院进行。该研究包括12例接受尸检的短期MCI患者。对插入导管的血管进行宏观和微观检查。
结果：总计，包括7例女性患者和5例男性患者,中位年龄为70岁(四分位距63~76岁).除了一个例外,所有患者在CICC期间接受常规血栓预防.大多数insertedCICC为9.5French（54％），并插入颈内静脉（92％）。CICC的中位时间为7天（四分位距1.8-20）。尸检时,在所有病例中均观察到血栓（100%），宏观和微观，连接到CICC的远端部分和/或相邻的血管壁。在所有病例中均可见血管壁中的炎症变化，8例(67%)出现不同程度的纤维化。
结论：这项尸检研究表明，导管相关的血栓形成与邻近的炎症和纤维化血管壁增厚非常普遍，尽管导管使用时间有限。这些发现的后果很重要，因为血栓可能导致肺栓塞，并可能导致导管相关感染，并且由于炎性和纤维化血管壁增厚可能演变成慢性静脉狭窄。此外，这些发现令人担忧，asCICC在现代医疗保健中是不可或缺的,并发症可能被作为CICC插入指征的一般疾病所掩盖.
