Santral venler yoluyla gerçekleştirilen kateterizasyon işlemlerinin retrospektif değerlendirilmesi
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Date
2015-12-29
Authors
Karaman, Emine Uzlaş
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda Anesteziyoloji ve Reanimasyon Anabilim Dalı tarafından gerçekleştirilen santral ven kateterizasyonu (SVK) işlemlerini retrospektif olarak inceleyerek oluşan mekanik komplikasyonları, nedenlerini ve işlemin başarısını etkileyen faktörleri belirlemeyi amaçladık. Kasım 2009-Haziran 2012 tarihleri arasında ameliyathane ve yoğun bakımda SVK işlemi gerçekleştirilen 922 hastanın verileri retrospektif incelendi. Hastaların demografik özellikleri, girişimin özellikleri, uygulayıcının deneyimi ve mekanik komplikasyonlar ile ilgili veriler değerlendirildi. Hastalardan 23’ü verilerin eksikliği nedeniyle çalışma dışı bırakıldı ve toplam 899 hasta incelendi. En sık sağ internal juguler venin (%84.1) kullanıldığı saptandı. Zor kateterizasyon (ikiden fazla deneme gereken) hasta yaşı (p<0.001), venin önceden kullanılmış olması (p<0.001), uygulayıcının deneyimi (p<0.001) ile ilişkiliydi. Hastaların %16.7’sinde komplikasyon geliştiği, en sık komplikasyonun arter ponksiyonu olduğu saptandı (%11.2). Kateter yerleştirilen veni daha önce kullanılmış olan, yaşı ≤8 olan, ikiden fazla deneme yapılan ve başarısız kateterizasyon yaşanan hastalarda komplikasyon oranı yüksek idi (p<0.001, p=0.008, p<0.001, p<0.001). Uygulayıcının eğitim süresinin 4 yıldan ve daha önce yerleştirdiği kateter sayısının 30 adetten az olması komplikasyon oranını arttırmıştı (p<0.001) (p<0.001). Sonuç olarak, uygulayıcının yeterli deneyime sahip olmaması ve başarısız kateterizasyon girişimleri SVK işlemini zorlaştırmakta ve komplikasyon oranını artırmaktadır. SVK işleminin; pediyatrik olgularda deneyimli kişilerce yapılması ve uygulayıcının ikiden fazla deneme yapması gerekiyorsa işlemi daha deneyimli kişiye devretmesi gerektiği kanısına varılmıştır.
The purpose of retrospective study is to determine mechanical complications, their reasons and factors related to success rate of central venous catheterizations (CVC) in 922 patients in the Department of Anaesthesiology and Reanimation between November 2009-June 2012.Demographic characteristics of patients, characteristics of attempts, experience of performer and mechanical complications were evaluated. 23 of patients were excluded and 899 patients were investigated. Mostly right internal jugular vein was used (%84.1). Difficult catheterization was related with age (p<0.001), previously used vein (p<0.001), experience of the performer (p<0.001). Complications occurred in 16.7% of patients, the most common was arterial puncture (11.2%). Complication rate was high in patients whose vein was used for previous catheterization, who were ≤8 years, who had more than 2 unsuccessful trials and who had failed catheterization (p<0.001,p=0.008,p<0.001,p<0.001). Training time less than 4 years and experience in CVC in less than 30 patients were increased the complication rate (p<0.001) (p<0.001). As a conclusion, performers who have less experience and previous failed catheterization attempts complicate CVC process and increase complication rate. It is suggested that CVC should be performed by experienced performers in children, attempts by inexperienced performers must be performed by supervision of experienced colleagues. If more than two percutaneous puncture is needed, the process should be continued by an experienced operator.
The purpose of retrospective study is to determine mechanical complications, their reasons and factors related to success rate of central venous catheterizations (CVC) in 922 patients in the Department of Anaesthesiology and Reanimation between November 2009-June 2012.Demographic characteristics of patients, characteristics of attempts, experience of performer and mechanical complications were evaluated. 23 of patients were excluded and 899 patients were investigated. Mostly right internal jugular vein was used (%84.1). Difficult catheterization was related with age (p<0.001), previously used vein (p<0.001), experience of the performer (p<0.001). Complications occurred in 16.7% of patients, the most common was arterial puncture (11.2%). Complication rate was high in patients whose vein was used for previous catheterization, who were ≤8 years, who had more than 2 unsuccessful trials and who had failed catheterization (p<0.001,p=0.008,p<0.001,p<0.001). Training time less than 4 years and experience in CVC in less than 30 patients were increased the complication rate (p<0.001) (p<0.001). As a conclusion, performers who have less experience and previous failed catheterization attempts complicate CVC process and increase complication rate. It is suggested that CVC should be performed by experienced performers in children, attempts by inexperienced performers must be performed by supervision of experienced colleagues. If more than two percutaneous puncture is needed, the process should be continued by an experienced operator.
Description
Bu çalışma, Türk Anesteziyoloji ve Reanimasyon Derneği 48. Ulusal Kongresi, 25-29 Ekim 2014, Ankara’da poster olarak sunulmuştur.
Keywords
Santral ven kateterizasyonu, Erişkin, Komplikasyon, Çocuk, Central venous catheterization, Risk faktörleri, Children, Adult, Risk factors, Complications
Citation
Karaman, E. U. vd. (2015). ''Santral venler yoluyla gerçekleştirilen kateterizasyon işlemlerinin retrospektif değerlendirilmesi''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 41(3), 115-124.