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Catéter venoso central subclavio, complicaciones a la inserción
Resumen
Introducción: los catéteres venosos centrales (CVC) son utilizados tanto en pacientes gravemente enfermos que ameritan monitorización hemodinámica y apoyo vasopresor, como en pacientes estables que requieren nutrición parenteral o quimioterapia. La colocación de un CVC subclavio (CVCs) puede presentar complicaciones severas incluso mortales. El objetivo del presente estudio fue determinar el éxito de la colocación de CVCs sin guía ultrasonográfica y el número y tipo de complicaciones asociadas a la inserción de estos.
Métodos: estudio de cohorte retrospectivo, que incluyó a todos los pacientes a los cuales se les coloco un CVCs en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI. Las variables estudiadas fueron: indicación médica para la colocación, sitio de inserción, duración, motivo de retiro y si se presentaron complicaciones.
Resultados: se estudió a un total de 283 pacientes de 16 a 95 años. En el 45% de los pacientes fue la primera colocación, el antecedente de una colocación previa no aumento las complicaciones. Las indicaciones para el CVCs fueron: nutrición parenteral, uso prequirúrgico, pacientes graves, quimioterapia, incapacidad para canalizar y plasmaféresis.
Conclusiones: la colocación de un CVCs por personal capacitado en pacientes sin factores de riesgo y aun sin apoyo ultrasonográfico es segura y eficaz, con complicaciones graves menores al 2% y sin mortalidad. Si los intentos se reducen a dos punciones, la morbilidad puede reducirse aún más.
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