ii
1 (1) 1 (2) 1 (3) 2 (4) 2 (5) 2 (6) 2 (7) 3 (8) 3 (9) 3 (10) 3 (11) 4 (12) 4 (13) 4 (14) 5 (15) 5 (16) 5 (17) 7 (18) 7 8 8 8 12 12 12 13 14 16 16 16 19 19 21 21 iii
21 23 23 23 23 24 25 25 25 27 28 29 iv
(1) ICU 1 (a) 2 (b) high PEEP (c) (d) (e) (2) Seldinger 3 Seldinger 3 EXCV SMAC12G 1 1 or 7Fr 2 UK 16G 2 1
(3) 3 3 (4) (5) 4 4 (6) 5 5 2
(7) ml (8) 3 (9) (10) 6 6 10cm 7 7 7 7 3
(11) (12) 8 8 (13) cm 4
(14) CVP 4 1315cm 1820cm 40~50cm (15) 9 9 U 10 10 (16) 14 2 2,, 5
RCT chlorhexidine silver sulfadiazine (ARROWg+ard Blue R ) chlorhexidine minocycline rifampicin (Cook SPECTRUM TM ) 3 ( ) ICU 11 11 6
2,5,6,7 2 (17) 2 ICU 33% 15% 8 1.9% 21.5% 9 4 10 (18) 2 50 50 11 3 3 1 6 12 (%) 6.3 9.4 3.1 4.9 9.0 15.0 < 0.1 0.2 1.2 2.1 3.8 4.4 NA 0.4 0.6 NA < 0.1 0.2 1.5 3.1 NA 6.3 11.8 6.2 10.7 12.8 19.4 Data are from Merrer et al., 9 Sznajder et al., 11 Mansfield et al., 12 Martin et al., 13 Durbec et al., 14 and Timsit et al. 15 NA denotes not applicable. 7
(1) (2) 1% R 510ml 25G (3) I.V R 18G1.75 2.5ml5ml25G (4) (5) 10 /ml 510ml (6) EXCV SMAC12G or 7Fr UK 16G 1. 1020 Trendelenburg 40 1.1 16 1.1 60 17 8
2. 3. 1.3 18 1.3.c 1.3.a 19 1.2 1.3 a b c c 9
4. 2.5ml+25G 5ml+ 18G a 5mm (a) mm (5) (b) 5mm 10cm (10) 12 3045 12cm 10
m 5. X 15c (11) (12) 1315cm EXCV (2) - 2 11
12 12 17 (2) (3) 1.5 (1) 1.4 1.4 1.5
20 (1) (2) (3) (4) (5) 20 310% (1)(2) 0.49%1021 5 43 (5) 0%1284 0 10 21 13
(1) 22 (3) 3 (2) 23 (4) (5) (6) 1.6 24,25 1.6 * * * * etc (7) 21 * 2.5% * < 0.5 cm Trendelenburg 3% 14
* 1% * 2% (8) * ( (3) * 26 * Trendelenburg 26 15
16 10 /ml (6) EXCV SMAC12G or 7Fr UK 16G R 2.1
(5) (c) (d) X 2.2 17
(10) (12) 18
2.3 2.5 29 2.3 2.4 2.5 1. 2. 3. 1.5 19
4. 20
R R 10 /ml (6) EXCV SMAC12G or 7Fr 2.5ml+25G 3.1 5ml+ 18G 21
(10) (12) (5) 22
31 3.1 1. 1 (16) 2. 1 (16) 3. 19 4. 30 31 3.2 3.2 1. 2. 32,33 23
32 24
(1) (2) 1% R 510ml 25G (3) I.V R 18G1.75 18G (4) (5) 10 /ml 510ml (6) 60cm (7) 1. 34 4.1 2. 33 4.1-4.3 4.3 4.4 40 50cm 4.2 25
4.3 4.4 18G 40cm 3. 4. 4.4 (11) (12) 26
4050cm EXCV (2) - 2 5. 27
2002 28
1 p1199-1204 2 David C. McGee, M.D., and Michael K. Gould, M.D.: Preventing Complications of Central Venous Catheterization.The NEW ENGLAND JOURNAL of MEDICINE 2003;Vol.348,No.12:1123-1133 3 4 5 Ma TY,Yoshinaka R,Banaag A,Johnson B,Davis S,Berman SM:Total parenteral nutrition via multilumen catheters dose not increase the risk of catheter-related sepsis:a randomized,prospective study.clin Infect Dis 1998;27:500-503 6 Farkas JC,Liu N,Bleriot JP,Chevret S,Goldstein FW,Carlet J:Single-versus triple-lumen central catheter-related sepsis:a prospective randomized study in a critically ill population.am J Med 1992;93:277-282 7 Clark-christoff N,Watters VA,Sparks W,Snyder P,Grant JP:Use of triple-lumen subclavian catheters for administration of total parenteral nutrition.jpen J Parenter Enteral Nutr 1992;16:403-407 8 Hirsch DR,Ingenito EP,Goldhaber SZ:Prevalence of deep venous thrombosis among patients in medical intensive care.jama 1995;274:335-337 9 Merrer J,De Jonghe B,Golliot F,et al:complications of femoral and subclavian venous catheterization in critically ill patients:a randomized controlled trial.jama 2001,286:700-707 10 Timsit JF,Farkas JC,Boyer JM,et all:central vein catheter-related thrombosis in intensive care patients:incidence,risk factors,and relationship with catheter-related sepsis.chest 1998;114:207-213 11 Sznajdar JI,Zveibil FR,Bitterman H,Weiner P,Bursztein S:Central vein catheterizaton:failure and complication rates by three percutaneus approaches.arch Intern Med 1986;146:259-261 12 Mansfield PF,Hohn DC,Fornage BD,Gregurich MA,Ota DM:Complications and failures of subclavian-vein catheterizaton:n Engl J Med 1994;331:1735-1738 13 Martin C,Eon B,Auffray JP,Saux P,Gouin F:Axillary or internal jugular central venous catheterizaton.crit Care Med 1990;18:400-402 14 Durbec O,Viviand X,Potie F,Vialet R,Albanese J,Martin C:A prospective evaluation of the use of femoral venous catheters in critically ill adults.crit Care Med 1997;25:1986-1989 15 Timsit JF,Bruneel F,Cheval C,et al.:use of tunneled femoral catheters to prevent catheter-related infection:a randomized,controlled trial.ann Intern Med 1999;130:729-735 29
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