| Popis: |
During the past few years clinical use of central venous cannulation has increased, principally because of the recognized benefits derived from monitoring central venous pressure and providing hyperosmolar parenteral alimentation. As experience has accumulated with placement and maintenance of vena caval catheters, various associated complications have become apparent. During recent months it seemed that complications were occurring at a rate out of proportion to the increased frequency with which we were employing this modality. Subsequent review of our experience with more than 350 central venous cannulations disclosed that preventable complications can be attributed to two primary factors; a more relaxed attitude toward critical points of catheter placement as an individual or group attains experience with this modality, and delegation of catheter care to nonsurgical personnel after a polyethylene cannula has been inserted. Prolonged central venous cannulation can be accomplished with minimal sequelae, if careful and persistent attention is directed toward certain details of catheter placement and maintenance. Herein we have outlined and emphasized precautions which will preclude occurrence of the most dangerous complications, and minimize the frequency with which the others occur. When employed with proper care, few untoward sequelae will detract from the over-all value of central venous cannulation, a proven clinical adjunct in the management of critically ill patients. |
