One case of patient with bilateral ectopic subclavian vein catheterization
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摘要: 2013年6月5日,笔者单位收治1例18岁严重烧伤伴重度吸入性损伤女性患者,入院后行右锁骨下静脉穿刺置管快速补液抗休克,伤后52 h拟行双上肢切削痂+右大腿中厚皮修复术。全身麻醉后因右侧静脉导管输液不畅,行左锁骨下静脉置管,患者出现室上性心动过速、血压下降,予补液扩容、强心、利尿等治疗,生命体征稍平稳,麻醉后约1.3 h开始手术。术后胸部X线片示左、右侧静脉导管远端分别位于右心房内和右颈内静脉内,立即拔除。此病例提醒临床医师锁骨下静脉置管时应注意防止导管异位,并于术后行胸部X线检查确认其位置。Abstract: One female patient aged 18 years, with severe burns and inhalation injury was admitted to our unit on June 5th, 2013. After admission, the right subclavian vein catheterization was performed for rapid fluid infusion against shock. Escharectomy on both upper extremities was planned to carry out and repaired with medium-thickness skin on right thigh 52 hours after injury. However, after general anesthesia, the right subclavian vein catheter was with poor fluid infusion, and the left subclavian vein catheterization was performed. Supraventricular tachycardia and decreased blood pressure occurred followed by fluid replacement and dilatation, cardiotonics, and diuretics. Postanesthetic 1.3 hours, the patient′s vital signs were stable, and the operation began. Postoperative chest X-ray film showed that distal ends of the left and right subclavian vein catheters were respectively located in the right atrium and the right internal carotid vein, and the catheters were removed immediately. This case suggests that clinical physician should be careful to prevent catheter heterotopia in subclavian vein catheterization, and postoperative routine chest X-ray examination is necessary to identify position of the catheter.
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Key words:
- Burns /
- Tachycardia /
- Subclavian vein catheterization /
- Heterotopia
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