bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2017-62-4-203-210bloodjour-672Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПериферические имплантируемые центральные венозные катетеры для обеспечения длительного сосудистого доступа у больных с геморрагическим синдромомPeripherally inserted central catheter for long-term vascular access in patients with hemorrhagic syndromehttps://orcid.org/0000-0001-7048-060XСпиринМ. В.SpirinM.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0001-8818-8949ГалстянГ. М.GalstyanG. M.

Галстян Геннадий Мартинович, доктор медицинских наук, заведующий научно-клиническим отделением реанимации и интенсивной терапии

125167, г. Москва

Galstyan Gennadiy M., MD, PhD, DSc., head of ICU department 

Moscow, 125167

gengalst@gmail.comhttps://orcid.org/0000-0002-7783-5861ПолеводоваО. А.PolevodovaO. A.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0002-9631-4543КудлайД. А.KudlayD. A.

125371, г. Москва

Moscow, 125371

https://orcid.org/0000-0002-4143-3094ПолянскаяТ. Ю.PolyanskayaT. Yu.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0001-7074-0926ЗозуляН. И.ZozulyaN. I.

125167, г. Москва

Moscow, 125167

ЛихачеваЕ. А.LikhachevaE. A.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0002-4827-8947ТроицкаяВ. В.TroitskayaV. V.

125167, г. Москва

Moscow, 125167

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава РоссииРоссияNational Research Center for HematologyRussian FederationФГБОУ ДПО «Институт повышения квалификации» ФМБА РоссииРоссияInstitute of Advanced Training of FMBARussian Federation201717102025624203210Copyright © Спирин М.В., Галстян Г.М., Полеводова О.А., Кудлай Д.А., Полянская Т.Ю., Зозуля Н.И., Лихачева Е.А., Троицкая В.В., 20252025Спирин М.В., Галстян Г.М., Полеводова О.А., Кудлай Д.А., Полянская Т.Ю., Зозуля Н.И., Лихачева Е.А., Троицкая В.В.Spirin M., Galstyan G.M., Polevodova O.A., Kudlay D.A., Polyanskaya T.Y., Zozulya N.I., Likhacheva E.A., Troitskaya V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/672

Выраженный геморрагический синдром является относительным противопоказанием к катетеризации центральных вен. В то же время в клинической практике нередко возникает необходимость катетеризации центральных вен у больных с нарушениями гемостаза.

Цель работы – анализ использования периферически имплантируемых центральных венозных  катетеров (ПИ-ЦВК) у больных с выраженными нарушениями гемостаза.

Результаты. Всего установили 16 ПИ-ЦВК 12 больным с геморрагическим синдромом (6 больных  гемофилией, из них у 4 – с наличием ингибитора к FVIII; 1 больная раком молочной железы и болезнью Виллебранда, 3 больных острыми промиелоцитарными лейкозами, 1 – множественной миеломой,  1 – миелодиспластическим синдромом). Гемостаз, при необходимости, обеспечивали введением рекомбинантного активированного фактора свертывания VII (rFVIIa). Срок использования ПИ-ЦВК составил от 5 сут до 1 г и 3 мес. Не было тромботических и инфекционных осложнений при использовании ПИ-ЦВК. ПИ-ЦВК могут рассматриваться как метод выбора для обеспечения длительного сосудистого доступа у больных с геморрагическим синдромом различного генеза. Их установка в условиях ультразвуковой навигации безопасна и эффективна. В зависимости от планируемого лечения, характера геморрагического синдрома подход к выбору ПИ-ЦВК (наличие клапана Грошонг®, силиконовые или высокопоточные полиуретановые катетеры, измерение центрального венозного давления и т.д.) должен быть дифференцированным. У этой категории больных ПИ-ЦВК могут рассматриваться как альтернатива нетуннелируемым катетерам и полностью имплантируемым сосудистым устройствам.

The hemorrhagic syndrome is the relative contraindication for the central venous access. However, in the clinical practice, many patients with hemorrhagic syndrome need a long-term vascular access.

Purpose of the study was to investigate the use of Peripherally Inserted Central Catheters (PICC)  in patients with severe hemostatic disorders.

Results. In total, 16 PICCs were implanted in 12 patients with hemorrhagic syndrome (6 hemophilia  patients, 4 of them with inhibitor to FVIII, 1 patient with breast cancer and Willebrand disease, 3 patients with acute promyelocytic leukemia, 1 patient with multiple myeloma and 1 patient with myelodysplastic  syndrome). Hemostasis was provided by recombinant activated factor VII (rFVIIa), platelet and cryoprecipitate transfusions. The period of use of PICCs varied from 5 days to 1 year and 3 months.  There were no thrombotic and infectious complications. PICC can be considered as a method of choice for long-term vascular access  in patients with hemorrhagic syndrome.

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The authors declare that there are no conflicts of interest present.