Травма центральных сосудов, приведшая к профузному кровотечению, после имплантации туннельных диализных катетеров у больных, находящихся на лечении гемодиализом

Abstract

The need for central venous catheters in patients on hemodialysis is very high. Even though complications of catheter implantation are rare (on average about 0.5% of cases, according to own data - 0.37%), their treatment is extremely difficult and, in most cases, requires a large surgery. We present four clinical observations. In the first case, during the puncture was damaged the left subclavian vein in the area of its fixation to the first rib and confluence with the internal jugular vein. The resulting heavy bleeding required a thoracotomy, the bleeding was stopped. The patient was discharged. In the second case, there was damage to the left common carotid artery. The defect was eliminated during the operation. The patient was discharged. In the third case, the right common carotid artery was damaged. During the first hours after the injury, the local hematoma did not grow, the condition remained stable. Four hours after physical exertion (stool), there was a rapid increase in hematoma, compression of the trachea, and suffocation. Attempts to intubate were unsuccessful. An emergency tracheostomy was performed. Despite this, the patient died. In the fourth case, the upper vena cava was damaged. In this case, the catheter was located in the projection of the right atrium on the frontal x-ray. The pleural cavity was drained. In connection with the ongoing bleeding on the pleural drainage, an emergency computer tomography was performed, where it was found that the catheter perforates the vein and was located in the pleural cavity. An emergency thoracotomy was performed, the vein defect was eliminated. The patient was discharged after long-term treatment. Thus, a series of clinical observations demonstrate that the diagnosis of severe complications of large vessel damage during the dialysis catheters implantation is difficult due to several factors: the patient's condition, anatomical features, comorbid background, and many localizations of possible damage to vessels. Complicated catheter implantation requires mandatory ultrasound control, observation in the intensive care unit, mandatory x-ray examination, and, if necessary, computer tomography for early detection of life-threatening conditions.