背景:这项实验研究的目的是阐明在连续肾脏替代疗法(CRRT)期间,中心静脉导管尖端之间的不同距离是否会影响药物清除。中心静脉导管(CVC)广泛用于重症监护患者的药物输注。如果患者接受CRRT,需要第二个中央透析导管(CDC)。在指南指导下插入CVC的地方,但是关于如何放置多个导管的建议很少。有迹象表明,在CVC中注入的药物的尖端靠近CDC的尖端,可以直接吸入透析机,有增加间隙的风险。然而,关于清除是否受不同CVC和CDC尖端位置影响的研究,当两个导管在同一血管中时,很少。
方法:在这个有18只仔猪的模型中,在CRRT期间通过CVC输注庆大霉素(GM)和万古霉素(VM)。CVC尖端从尾部放置在与CDC尖端相关的不同位置,即,靠近心脏,到颅骨,即,在心脏的远端.在四个不同位置进行CRRT大约30分钟后,对血清和透析液浓度进行采样:当CVC尖端尾端为2厘米(2)时,在同一级别(0),和2(-2)和4(-4)厘米头端CDC。计算了间隙。进行了混合线性模型,显著性水平设定为p<0.05。
结果:GM的间隙在+2厘米处有中值,0厘米,-2厘米和-4厘米的17.3(5.2),18.6(7.4),20.0(16.2)和26.2(12.2)ml/min,分别(p=0.04)。VM间隙的中值为+2cm,0厘米,-2厘米和-4厘米的16.2(4.5),14.7(4.9),19.0(10.2)和21.2(11.4)ml/min,分别(p=0.02)。
结论:CVC和CDC尖端之间的距离可以影响CRRT期间的药物清除。CVC相对于CDC尖端的颅端与尾端位置导致最高间隙。
BACKGROUND: The aim of this experimental study was to elucidate whether different distances between central venous catheter tips can affect drug clearance during continuous renal replacement therapy (CRRT). Central venous catheters (CVCs) are widely used in intensive care patients for drug infusion. If a patient receives CRRT, a second central dialysis catheter (CDC) is required. Where to insert CVCs is directed by guidelines, but recommendations regarding how to place multiple catheters are scarce. There are indications that a drug infused in a CVC with the tip close to the tip of the CDC, could be directly aspirated into the dialysis machine, with a risk of increased clearance. However, studies on whether clearance is affected by different CVC and CDC tip positions, when the two catheters are in the same vessel, are few.
METHODS: In this model with 18 piglets, gentamicin (GM) and vancomycin (VM) were infused through a CVC during CRRT. The CVC tip was placed in different positions in relation to the CDC tip from caudal, i.e., proximal to the heart, to cranial, i.e., distal to the heart. Serum and dialysate concentrations were sampled after approximately 30 min of CRRT at four different positions: when the CVC tip was 2 cm caudally (+ 2), at the same level (0), and at 2 (- 2) and 4 (- 4) cm cranially of the tip of the CDC. Clearance was calculated. A mixed linear model was performed, and level of significance was set to p < 0.05.
RESULTS: Clearance of GM had median values at + 2 cm, 0 cm, - 2 cm and - 4 cm of 17.3 (5.2), 18.6 (7.4), 20.0 (16.2) and 26.2 (12.2) ml/min, respectively (p = 0.04). Clearance of VM had median values at + 2 cm, 0 cm, - 2 cm and - 4 cm of 16.2 (4.5), 14.7 (4.9), 19.0 (10.2) and 21.2 (11.4) ml/min, respectively (p = 0.02).
CONCLUSIONS: The distance between CVC and CDC tips can affect drug clearance during CRRT. A cranial versus a caudal tip position of the CVC in relation to the tip of the CDC led to the highest clearance.