■肌萎缩侧索硬化症(ALS)患者可能需要进行肠外营养的中心静脉导管插入术,抗生素治疗,或血液采样。可考虑不同的静脉接入装置-中央插入中心导管(CICC),外周中心静脉导管(PICC),和股骨插入的中央导管(FICC)-取决于患者的临床状况。无论访问类型如何,截瘫或四肢瘫痪通常被认为是导管相关性血栓形成(CRT)的危险因素.
■这项回顾性研究分析了115例截瘫或四肢瘫痪患者的CRT和其他与中心静脉通路相关的非感染性并发症的发生率,其中大多数受ALS影响(n=109)。
■在34个月的时间内,从2021年1月到2023年10月,我们插入了75个FICC,29CICC,和11个PICCs。仅在上肢运动保留的患者中插入PICC。所有设备均由受过训练的操作员采用适当的插入束插入。我们没有立即或早期并发症。尽管只有61.7%的患者采用了抗血栓预防,我们没有症状性CRT.其他非感染性并发症很少见(115例患者中有4例)。
■这些结果表明(a)截瘫或四肢瘫痪的存在不一定与CRT的风险增加有关,(b)采用精心设计的插入束在最大程度地减少非感染性并发症方面起着关键作用,和(c)在截瘫/四肢瘫痪患者中,通过直接在大腿中部的股浅静脉插管插入FICC可能具有与一般人群中描述的相同的优点。
UNASSIGNED: Central venous catheterization may be required in patients with amyotrophic lateral sclerosis (ALS) for parenteral nutrition, antibiotic treatment, or blood sampling. Different venous access devices can be taken into consideration-centrally inserted central catheters (CICC), peripherally inserted central catheters (PICC), and femorally inserted central catheters (FICCs)-depending on the clinical conditions of the patients. Regardless of the type of access, the presence of paraplegia or tetraplegia is commonly considered a risk factor for catheter-related thrombosis (CRT).
UNASSIGNED: This retrospective study analyzes the rate of CRT and other non-infectious complications associated with central venous access in a cohort of 115 patients with paraplegia or tetraplegia, most of them affected by ALS (n = 109).
UNASSIGNED: In a period of 34 months, from January 2021 to October 2023, we inserted 75 FICCs, 29 CICCs, and 11 PICCs. PICCs were inserted only in patients with preserved motility of the upper limbs. All devices were inserted by trained operators adopting appropriate insertion bundles. We had no immediate or early complication. Though antithrombotic prophylaxis was adopted only in 61.7% of patients, we had no symptomatic CRT. Other non-infectious complications were infrequent (4 out of 115 patients).
UNASSIGNED: These results suggest (a) that the presence of paraplegia or tetraplegia is not necessarily associated with an increased risk of CRT, (b) that the adoption of well-designed insertion bundles plays a key role in minimizing non-infectious complications, and (c) that the insertion of FICCs by direct cannulation of the superficial femoral vein at mid-thigh in paraplegic/tetraplegic patients may have the same advantages which have been described in the general population.