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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rmt</journal-id><journal-title-group><journal-title xml:lang="ru">Общая реаниматология</journal-title><trans-title-group xml:lang="en"><trans-title>General Reanimatology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1813-9779</issn><issn pub-type="epub">2411-7110</issn><publisher><publisher-name>FSBI "SRIGR" RAMS</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15360/1813-9779-2024-5-55-69</article-id><article-id custom-type="elpub" pub-id-type="custom">rmt-2478</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ПРАКТИКУЮЩЕМУ ВРАЧУ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>FOR PRACTIONER</subject></subj-group></article-categories><title-group><article-title>Осложнения при установке систем центрального венозного доступа в педиатрической онкологической практике (серия клинических наблюдений)</article-title><trans-title-group xml:lang="en"><trans-title>Procedural Complications of Central Venous Catheter Placement in Pediatric Oncology Practice (a Clinical Case Series)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7945-2565</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Щукин</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shchukin</surname><given-names>Vladislav V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Владислав Владимирович Щукин</p><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">79031241211@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4364-8937</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Леонов</surname><given-names>Н. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Leonov</surname><given-names>Nikolay P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">nikoleonov@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Спиридонова</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Spiridonova</surname><given-names>Elena A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p><p>127994, ГСП-4, г. Москва, Рахмановский пер, д. 3</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p><p>Rakhmanovsky per., GSP-4, 127994 Moscow</p><p> </p></bio><email xlink:type="simple">spiridonovaea@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Селиванов</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Selivanov</surname><given-names>Vladimir V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">vselive@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дергунова</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Dergunova</surname><given-names>Ekaterina V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">katrinka-koz@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Новичкова</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Novichkova</surname><given-names>Galina A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">gnovichkova@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мякова</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Myakova</surname><given-names>Natalia V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">nmiakova@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Грачев</surname><given-names>Н. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Grachev</surname><given-names>Nikolay S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">nick-grachev@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4537-2548</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Быков</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bykov</surname><given-names>Mikhail V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ул. Островитянова, д. 1</p><p>111123, г. Москва, ул. Новогиреевская, д. 3а </p></bio><bio xml:lang="en"><p>1 Ostrovityanov Str., 117997 Moscow</p><p>3a Novogireevskaya Str., 111123 Moscow</p></bio><email xlink:type="simple">mikhail_v_bykov@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9631-0967</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Быстрова</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Bystrova</surname><given-names>Anastasia A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>119049, г. Москва, 4-й Добрынинский переулок, д. 1/9 </p></bio><bio xml:lang="en"><p>1/9 4th Dobrininsky Lane, 119049 Moscow</p></bio><email xlink:type="simple">Iam@anastabistrova.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-7894-3542</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Григорян</surname><given-names>Р. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Grigoryan</surname><given-names>Rina S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ул. Островитянова, д. 1 </p></bio><bio xml:lang="en"><p>1 Ostrovityanov Str., 117997 Moscow</p></bio><email xlink:type="simple">vvs1971@mail.ru</email><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7805-5616</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Матинян</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Matinyan</surname><given-names>Nune V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ул. Островитянова, д. 1 </p><p>115522, г. Москва, Каширское шоссе, д. 24 </p></bio><bio xml:lang="en"><p>1 Ostrovityanov Str., 117997 Moscow</p><p>24 Kashirskoe shosse, 115522 Moscow</p></bio><email xlink:type="simple">n9031990633@yandex.ru</email><xref ref-type="aff" rid="aff-6"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6716-7564</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Петрушин</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Petrushin</surname><given-names>Anton V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p></bio><email xlink:type="simple">Anton.Petrushin@fccho-moscow.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лоайса</surname><given-names>У.</given-names></name><name name-style="western" xml:lang="en"><surname>Loaisa</surname><given-names>Hugo</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997, г. Москва, ГСП-7, ул. Саморы Машела, д. 1</p><p>117997, г. Москва, ул. Островитянова, д. 1 </p></bio><bio xml:lang="en"><p>Samora Mashela Str., GSP-7, 117997 Moscow</p><p>1 Ostrovityanov Str., 117997 Moscow</p></bio><email xlink:type="simple">pamius@mail.ru</email><xref ref-type="aff" rid="aff-7"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр детской гематологии,  онкологии и иммунологии им. Дмитрия Рогачева Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>D. Rogachev National Medical Research Center for Pediatric Hematology</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр детской гематологии,  онкологии и иммунологии им. Дмитрия Рогачева Минздрава России; Российский университет медицины Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>D. Rogachev National Medical Research Center for Pediatric Hematology; Russian University of Medicine, Russian Ministry of Health</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава России; Центральный НИИ эпидемиологии Роспотребнадзора России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>N. I. Pirogov Russian National Medical Research University; Central Research Institute of Epidemiology, Russian Rospotrebnadzor</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Морозовская детская городская клиническая больница Департамента здравоохранения г. Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Morozov Children's City Clinical Hospital, Moscow Health Department</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава России</institution><country>Russian Federation</country></aff><aff xml:lang="en"><institution>N. I. Pirogov Russian National Medical Research University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-6"><aff xml:lang="ru"><institution>Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава России; НИИ Детской онкологии и гематологии &#13;
Национального медицинского исследовательского центра онкологии им. Н. Н. Блохина Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>N. I. Pirogov Russian National Medical Research University; Research Institute of Children's Oncology and Hematology, N. N. Blokhin National Medical Research Center for Oncology, Russian Ministry of Health</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-7"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр детской гематологии,  онкологии и иммунологии им. Дмитрия Рогачева Минздрава России; Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>D. Rogachev National Medical Research Center for Pediatric Hematology; N. I. Pirogov Russian National Medical Research University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>01</day><month>10</month><year>2024</year></pub-date><volume>20</volume><issue>5</issue><fpage>55</fpage><lpage>69</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Щукин В.В., Леонов Н.П., Спиридонова Е.А., Селиванов В.В., Дергунова Е.В., Новичкова Г.А., Мякова Н.В., Грачев Н.С., Быков М.В., Быстрова А.А., Григорян Р.С., Матинян Н.В., Петрушин А.В., Лоайса У., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Щукин В.В., Леонов Н.П., Спиридонова Е.А., Селиванов В.В., Дергунова Е.В., Новичкова Г.А., Мякова Н.В., Грачев Н.С., Быков М.В., Быстрова А.А., Григорян Р.С., Матинян Н.В., Петрушин А.В., Лоайса У.</copyright-holder><copyright-holder xml:lang="en">Shchukin V.V., Leonov N.P., Spiridonova E.A., Selivanov V.V., Dergunova E.V., Novichkova G.A., Myakova N.V., Grachev N.S., Bykov M.V., Bystrova A.A., Grigoryan R.S., Matinyan N.V., Petrushin A.V., Loaisa H.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.reanimatology.com/rmt/article/view/2478">https://www.reanimatology.com/rmt/article/view/2478</self-uri><abstract><p>В детской онкологии и гематологии практически невозможно обойтись без центрального венозного доступа, поэтому частота катетеризаций центральных вен у пациентов этого профиля остается высокой. Процесс установки устройств венозного доступа может сопровождаться развитием осложнений, в том числе жизнеугрожающих. </p><sec><title>Цель</title><p>Цель. Оценить возможные причины развития осложнений при установке систем центрального венозного доступа для разработки мер профилактики.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В анализ включили 1512 авторских наблюдений у пациентов в возрасте от 1 мес. до 20 лет, находящихся на лечении в НМИЦ ДГОИ им. Д. Рогачева в период 2019–2022 г. Рассмотрели 10 осложнений: неоднократная пункция вены, расположение проводника/катетера в неправильном положении, узлообразование проводника, жизнеугрожающие аритмии, фиксация проводника в трабекулярной сети правого желудочка, пункция артерии, пневмоторакс, гематоракс, пункция ткани легкого, синдром Горнера. Кроме того, выделили 4 редких осложнений, таких как: повреждение диафрагмального нерва, тампонада сердца, альвеолярное кровотечение, псевдоаневризма артерии. </p></sec><sec><title>Результаты</title><p>Результаты. Основной причиной развития всех осложнений является механическое повреждение иглой или проводником/катетером анатомических структур. В случае повреждения целостности сосуда и развития гематомы к повреждающим причинам присоединяется компрессия гематомой. В развитии таких осложнений как узлообразование проводника и аритмии сердца играет роль чрезмерно глубокое введение проводника. Основным методом профилактики развития осложнений является обучение медицинского персонала и тщательное соблюдение алгоритмов катетеризации вен.</p></sec><sec><title>Заключение</title><p>Заключение. Катетеризация центральных вен остается манипуляцией, сопровождаемой возможным развитием осложнений. Применение ультразвуковой навигации в настоящее время не позволяет полностью избежать развития осложнений, но увеличивает вероятность пункции вены с первой попытки, что способствует снижению частоты их развития. Понимание причин развития различных видов осложнений, в том числе редких, при установке систем центрального венозного доступа позволяет своевременно их диагностировать и оказывать необходимую помощь.</p></sec></abstract><trans-abstract xml:lang="en"><p>The availability of central venous access is the cornerstone of contemporary pediatric oncology and hematology. As a result, the percentage of pediatric patients receiving infusion chemotherapy who require a central line remains high. Central venous catheter insertion can be associated with procedural complications, including life-threatening ones.</p><p>Aim — to investigate the potential factors leading to complications during central venous catheterization in order to develop preventive strategies.</p><sec><title>Materials and methods</title><p>Materials and methods. The study included 1,512 original cases of patients aged 1 month to 20 years treated at the D. Rogachev National Research Medical Center between 2019 and 2022. The following 10 complications were examined: failed first venipuncture attempt, guidewire/catheter malpositioning, guidewire knotting, lifethreatening arrhythmias, guidewire entrapment in the trabecular network of the right ventricle, arterial puncture, pneumothorax, hemothorax, puncture of lung parenchyma, Horner's syndrome. In addition, four rare complications were noted, including phrenic nerve injury, cardiac tamponade, alveolar hemorrhage, and arterial pseudoaneurysm.</p></sec><sec><title>Results</title><p>Results. The primary cause of all complications was direct mechanical injury to anatomical structures by a needle or guidewire/catheter. When inadvertent vascular injury and bleeding occur, the resulting hematoma may lead to further damage by compressing soft tissues. Excessively deep insertion of the guidewire may cause its knotting or cardiac arrhythmias. Adequate physician training and strict adherence to procedural protocols are essential to avoid these complications.</p></sec><sec><title>Conclusion</title><p>Conclusion. Central venous catheterization remains a procedure with potential complications. Although ultrasound guidance does not eliminate all risks, it increases the likelihood of successful venipuncture at the first attempt, thereby reducing complication rates. Recognizing the potential causes of procedural complications during central venous access placement, including uncommon ones, facilitates early diagnosis and appropriate medical intervention. </p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>центральный венозный катетер</kwd><kwd>катетеризация центральной вены у детей</kwd><kwd>осложнение катетеризации центральной вены у детей</kwd><kwd>пневмоторакс</kwd><kwd>гематоракс</kwd><kwd>неврологические нарушения у детей</kwd><kwd>тампонада сердца</kwd><kwd>псевдоаневризма</kwd><kwd>педиатрическая онкологическая практика</kwd></kwd-group><kwd-group xml:lang="en"><kwd>central venous catheter</kwd><kwd>central venous catheterization in children</kwd><kwd>complication of central venous catheter placement in children</kwd><kwd>pneumothorax</kwd><kwd>hemothorax</kwd><kwd>neurological disorders in children</kwd><kwd>cardiac tamponade</kwd><kwd>pseudoaneurysm</kwd><kwd>pediatric oncology practice</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Askegard-Giesmann J. 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