[情報] [NEJM image] 本週是來自對岸紹興市人民醫院捅出的CVP蔞子

[KimiNoTame (台中)]

http://tw.myblog.yahoo.com/jw!jPbTDdCYHw7qzGOCAmSl6_en/article?mid=139


[NEJM image] 本週是來自對岸的喔！！有關『CVP的併發症』！！


這個禮拜NEJM的image也滿妙的～

簡直是太。驚。人。了！

而且是來自咱們對岸的『浙江省紹興市人民醫院』

Complication of Central Venous Catheterization


一個40歲的先生，罹患克隆氏症，開了一個因沾黏造成腸阻塞的刀。

術後，心臟科醫師幫他放CVP，subclavian的。

放的過程很順利。

三週後，已出院，病人的右腿有輕微的疼痛與水腫。用抗生素治療一週，症狀便改善。

手術後六個月，病人開始有『後頸痛』。





原。來。啊。～

CVP的guide wire從脖子後面穿出來了呢（圖A）！！（大驚）！



照CT發現還有一部份凹在裡面（圖B）～～

穿出來的部分好拿，可是凹在裡面隱靜脈的難拿啊！

所以就全身麻醉go in把它拿出來了～

可是那條靜脈也廢了。。。

一年追蹤後，沒有什麼症狀了～～



這篇文章讓我想起兩件事：

1. 今年金馬獎的熱門片：【詭絲】（圖A超像的！）

2. 我的同學，某CVP強者，也差點發生這種事（聽他講的時候，我緊張得大腿夾超緊～）

3. 紹興酒真好喝，好久沒喝了。（不過上班不能喝酒酒喔～）



A 40-year-old man with Crohn's disease underwent an uncomplicated operation involving lysis of adhesions that were causing intestinal obstruction. After surgery, a cardiologist inserted a central venous catheter through the left subclavian vein. No problems with catheterization were noted. Three weeks later, after discharge, mild pain and edema developed in the patient's right lower leg. He was treated with antibiotics for 1 week, and his symptoms diminished. Six months after the operation, the patient
presented with posterior cervical pain. A guide wire, presumably lost during the insertion of the central venous catheter, was protruding from the back of his neck (Panel A, arrow). A computed tomographic scan showed the fractured guide wire in the central venous system (Panel B, arrows). The wire protruding from the back of the neck was removed easily; however, it was difficult to remove the part of the wire involving the saphenous vein, and an open procedure with general anesthesia was required. The
involved leg vein was thrombosed and occluded. At 1 year of follow-up, the patient was free of symptoms and signs.


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推 clerk:CVP的全名是?我們vs常常唸說這種台灣通用講法是錯的.
推 Copper:CVC....central venous catheter
推 KimiNoTame:CVP是CVC量出來的"P"ressure吧～
推 madguy:不是No problems with catheterization were noted嗎?
→ madguy:怎麼又presumably lost during the insertion of CVC?
推 BLACKJJJ:CVC是所有central line的統稱（包含port/Hickman/etc）
→ BLACKJJJ:而『CVP line』比較是用來專指各位在講的那玩意
推 furtwangler:P可以用placement代表所有放在那邊的東西