tailieunhanh - Báo cáo y học: "What is the best site for central venous catheter insertion in critically ill patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về y học đề tài: What is the best site for central venous catheter insertion in critically ill patients? | Available online http content 7 6 397 Commentary What is the best site for central venous catheter insertion in critically ill patients Jean-Franọois Timsit Réanimation médicale et infectieuse Hôpital Bichat - Claude Bernard Paris France Correspondence Jean-Franọois Timsit Published online 28 March 2003 Critical Care 2003 7 397-399 DOI cc2179 This article is online at http content 7 6 397 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract The choice of the best central venous access for a particular patient is based on the rate and the severity of failures and complications. Based on two recent papers internal jugular access is associated with a low rate of severe mechanical complications in the intensive care unit as compared with subclavian access and it is preferable for short-term access 5-7 days and for haemodialysis catheters. Subclavian access is associated with a lower risk for infection and is the route of choice in experienced hands if the risk for infection is high central venous catheter placement 5-7 days or if the risk for mechanical complications is low. The femoral route is associated with a higher risk for infection and thrombosis as compared with the subclavian route . It should be restricted to patients in whom pneumothorax or haemorrhage would be unacceptable. Keywords catheter catheter-related infection complications femoral iatrogenic jugular pneumothorax subclavian Central venous catheter CVC insertion is required in many critically ill patients. Selection of the insertion site should be based both on the ease of placement and on the risks associated with the procedure. The latter include infection thrombosis and mechanical complications. Two recently published papers 1 2 have provided valuable new information on this issue. I Subclavian versus internal jugular approach There is a dearth of sound data comparing various CVC insertion sites. No well conducted .

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