经右颈内静脉置管长度计算公式的探讨

目的探讨经右侧颈内静脉置管长度的简易公式,提高深静脉置管深度的准确性,减少置管后的并发症。方法选择2015年6月至2015年12月我院骨科收治的需要经右颈内静脉留置中心静脉导管的成年患者67例。所有患者均采用目前临床上常用的前路法经右颈内静脉置管时进针定位及方向,试穿成功后,置入J形导丝,引导置入中心静脉导管,采用X射线透视检查方法确定中心静脉导管置入的具体位置,中心静脉导管置入的正确位置应为右第1前肋下缘至右第3前肋上緣。收集并推算导管置入正确位置的深度与患者身高的相关性计算公式。结果 67例患者平均身高为162.4 cm,平均置入深度为15.9 cm;其中男34例,平均身高为168.6 cm,平均置入深度为16.5 cm;女33例,平均身高为155.6 cm,平均置入深度为15.2 cm。中心静脉导管置入深度的简易计算公式:深度(cm)=身高(cm)×0.088+1.8(r=0.652,P0.01)。结论成年患者经右颈内静脉置管正确深度的简易计算公式为:深度(cm)=身高(cm)×0.088+1.8(r=0.652,P0.01)。     

静脉内心电图引导中心静脉置管新技术的临床应用

目的 评估新型心电图（ECG）引导中心静脉置管技术的有效性和安全性。方法 80例临床拟行中心静脉置管的择期手术全麻病人,根据置管方式分为颈内静脉（组1）和锁骨下静脉（组2）两组各40例。导管深度和方向的确定依据ECG中II导P波的变化。记录置管深度、中心静脉压（CVP）以及相关并发症。导管固定后采用X-ray（后前位胸片）确定导管位置。结果 采用ECG引导方式,其置管成功率约为98.7%(77/78) 。同时,其置入深度较传统方式浅（P＜0.05）结论 新型静脉内ECG引导中心静脉置管技术可有效提高中心静脉置管到位率,指导置管方向,提高安全性并降低相关费用。     

肝移植术中心静脉穿刺置管的解剖定位研究

目的比较解剖定位颈内静脉和锁骨下静脉两种路径行中心静脉穿刺置管的成功率和并发症,为临床选择安全有效的穿刺路径提供参考。方法限期肝移植手术患者随机交叉研究,随机确定颈内静脉和锁骨下静脉穿刺的先后顺序。全身麻醉诱导后,由同一组麻醉医师依据解剖定位标志按确定的穿刺顺序完成颈内静脉穿刺置管、锁骨下静脉穿刺置管。记录成功置管前静脉穿刺次数、引导钢丝置入次数,置管时间;同时记录误入动脉、血肿形成、气胸等并发症的发生率。结果 42例限期肝移植手术患者入选该研究。颈内静脉和锁骨下静脉穿刺置管的次数分别为(2.3±0.7)次,(2.9±1.4)次(n=42,P0.05),置管时间分别是(1.58±0.49)min,(2.24±1.01)min(n=42,P0.05)。1例患者行颈内静脉穿刺时误入颈动脉,并发血肿;1例患者行锁骨下静脉穿刺后出现血肿。结论解剖定位穿刺颈内静脉比锁骨下静脉更容易更快捷。     

两种不同体位对减少PICC置管中颈静脉异位的比较

目的：探索可降低PICC置管过程中颈静脉异位的方法。方法将2013年1月~2014年5月272例PICC置管患者随机分为实验组和对照组两组,分别采用手压法(实验组)和下颌压肩法(对照组),置管后在X线下进行导管定位。结果两种颈内静脉异位率有明显差异(P<0.05)。结论采用手压法的实验组明显优于采用下颌压肩法的对照组。     

老年患者中心静脉置管分析

目的总结对老年患者施行中心静脉置管的经验,寻找对老年患者施行中心静脉置管的最短时间和最佳部位。方法对三年来施行过中心静脉置管术的病例进行分析。结果总置管成功率为96.2%,失败率为3.8%。虽然经右颈内静脉置管的首次成功率与经右锁骨下静脉置管的首次成功率相比无显著性差异（P〉0.05）,但经右颈内静脉置管时间较经右锁骨下静脉置管时间短（P〈0.05）。结论老年患者施行中心静脉穿刺置管术条件复杂、情况多变,置管难度较大,经右颈内静脉置管较经右锁骨下静脉置管更为省时、安全、可行。     

经食管超声技术在婴幼儿中心静脉管穿刺定位中的应用

目的探讨经食管超声技术(TEE)不同径路行婴幼儿中心静脉导管穿刺定位的可行性及临床应用价值。方法选择择期行心血管手术的婴幼儿100例,共分两个径路,右颈内静脉以及右锁骨下静脉径路。每个径路各为50例,其中每个径路里25例采用经食道超声技术定位中心静脉导管置入的深度,25例根据身高年龄以及体重确定中心静脉导管的置入深度,并与胸部X线相应胸椎水平进行对比。结果所有中心静脉导管经TEE定位后管尖位置均能准确的定位于第4胸椎(T4)与第6胸椎(T6)水平之间。结论 TEE可以为婴幼儿中心静脉管的定位提供一个客观、直接的定位标准。     

植入式静脉输液港相关并发症的临床分析

目的探讨乳腺癌患者使用植入式静脉输液港相关并发症及其临床处理方法。方法回顾性分析我院2014年1月至2016年3月755例乳腺癌患者使用植入式静脉输液港化疗后并发症及其临床处理方法。结果 753例置港成功并已顺利取港,输液港总置管时间为110~940 d,平均置管时间为147.33 d。输液港并发症为导管异位、导管相关性血栓形成、导管脱落、港体外露及输液港相关性血流感染,发生率分别为0.79%(6/755)、27.81%(210/755)、0.13%(1/755)、0.93%(7/755)和0.13%(1/755)。其中经左侧颈内静脉穿刺置港的并发症发生率34.88%,右侧为25.74%,左右对比差异有统计学意义(P=0.008)。左侧输液港置入血栓发生率为33.10%,右侧为24.68%,左右侧对比差异有统计学意义(P=0.013)。结论乳腺癌患者化疗期间使用植入式静脉输液港化疗安全有效,经右侧颈内静脉置入输液港并发症发生率低;输液港最常见的并发症为输液港导管周围无症状附壁血栓形成,应予以重视。     

18G套管针应用于成人颈内静脉穿刺术的可行性研究

目的探讨18G套管针用于成人中心静脉穿刺置管术的可行性。方法回顾性分析2017年4月至8月在局部麻醉下进行中心静脉置管术的60例患者的临床资料。将60例患者随机分为对照组和观察组,穿刺置管部位选择颈内静脉,对照组采用常规穿刺针进行穿刺置管,观察组采用18G套管针替代常规穿刺针进行穿刺置管。结果 2组患者穿刺置管成功率比较差异无统计学意义(P0.05);与对照组相比,观察组的一次置导丝成功率较高,穿刺时间明显缩短,在穿刺操作期间疼痛评分较低,术后患者满意度较高,2组比较差异均具有统计学意义(P0.05)。结论 18G套管针能够很好地完成中心静脉穿刺置管,在清醒患者中该方法具有很大的优势,部分导丝置入困难的患者也可以采用。     

PICC置管在肿瘤化疗中的应用与护理

目的：探讨经外周静脉置入中心静脉导管术(PICC)在肿瘤化疗中的应用与护理。方法选择60例肿瘤患者,给予PICC置管静脉化疗,观察其治疗和护理效果。结果置管成功率为100%。60例患者全部顺利完成化疗。导管留置时间35~182d。导管留置期间发生静脉炎4例,穿刺点出血5例,导管堵塞2例,导管移位2例。结论PICC置管具有创伤小、留置时间长、并发症少、维护简便和避免反复静脉穿刺等优点,是一种良好的静脉化疗通道。     

后入路颈内静脉穿刺置管386例分析

目的 探讨和总结后入路颈内静脉穿刺置管技术要点及术中注意事项.方法 我院自2011年1月至2012年1月接受后入路颈内静脉穿刺置管患者共386例,回顾性分析穿刺过程中及穿刺后并发症情况,总结穿刺技术要点.结果 术中并发症共15例(3.9％),其中误穿动脉5例(1.3％),穿刺置管失败5例(1.3％),血气胸2例(0.5％),心律失常1例(0.26％),术中出血2例(0.5％)；术后并发症共13例(3.4％),其中导管感染5例(1.3％),导管周围渗液2例(0.5％),导管阻塞4例(1.0％),局部血肿2例(0.5％).结论 后入路颈内静脉穿刺置管术前定位非常重要,规范操作可以降低术中及术后并发症的发生率.     

Surgically important variations of the jugular veins

Knowledge of variations of veins of head and neck in relation to external jugular, anterior jugular, internal jugular, and facial veins is important to surgeons doing head and neck surgery as well as to radiologists doing catheterization and to clinicians in general. In the current case, multiple variations in the veins of the left side of neck are reported. The anterior division of retromandibular vein was absent. The facial vein continued as anterior jugular vein. The internal jugular vein was duplicated above the level of hyoid bone. There was a large communicating vein between the anterior jugular vein and anterior division of internal jugular vein. Lingual vein drained into the communicating vein. Jugular venous arch was abnormally large, doubled, and highly placed. The veins of the right side were normal.     

Topographical anatomy of central venous system in extremely low-birth weight neonates less than 1000 grams and the effect of central venous catheter placement

Central venous catheterization is widely used in neonatology. Although ultrasonic guidance for central venous catheter placement is available, complications occur significantly more frequently in infants, especially neonates, than in adults. This study seeks to determine the characteristics, topographical conditions, regional relationships, and diameters of the venous structures of the upper extremity and the thoracic central venous system in extremely small preterm neonates (mean: 900 g). Nine formaldehyde-fixed preterm stillborns were prepared (mean 27 2/7 weeks' gestational age). The anatomical preparation involved the complete thoracic wall, neck and shoulder region, and preparation of the upper extremities. It was shown that the course of the internal jugular vein can be influenced by rotation of the head. Maximum head rotation (80°) to the contralateral side leads the internal jugular vein to overlap the common carotid artery and sharpens the confluence angle of the internal jugular into the brachiocephalic vein. We propose that this has the potential to result in dislocation of the catheter. Less rotation of the head (<30°) is favorable as the internal jugular vein and common carotid artery run in parallel. Commonly used central venous catheters (2F-4F) may not occlude the vascular lumen completely. Small central venous cannulation using a single-orifice catheter through arm veins (1F) may also not occlude peripheral vessels of the upper extremity (cephalic and basilic veins). The right internal jugular vein has a straight course, appears suitable for central venous access and less hazardous, especially when using stiff catheters. The use of small straight wire guides is recommended.     

经左颈静脉插管肝内门-体静脉分流术的应用解剖

为给临床经左颈静脉插管行肝内门 -体静脉支架分流术提供解剖学依据 ,在 4 8例成人尸体上解剖并观测了双侧颈内静脉、头臂静脉、上腔静脉、右心房、下腔静脉上段的长度、外径、以及各有关静脉间的角度。结果为左颈内静脉长度 :10 6.9± 18.3 m m,外径 :13 .6± 3 .4 mm ;左头臂静脉长度 :66.3± 10 .8mm ,外径 :15 .9± 4 .1mm;上腔静脉长度 :4 8.5± 9.8mm,外径 :2 1.4± 8.4 mm;右心房长度 :68.7± 17.4 m m,上口外径 :2 0 .2± 4 .7mm,下口外径 :2 3 .9± 6.0 m m;下腔静脉上段长度 :2 1.5± 6.5 m m;左颈内静脉延长线与左头臂静脉间的角度 :4 5 .5°± 10 .3°,左头臂静脉延长线与上腔静脉间的角度 :5 8.3°± 12 .7°;5 8.3°± 12 .7°;左颈内静穿刺点至肝静脉口的总长 :2 4 3 .2± 2 3 .6m m。结论 :在经左颈内静脉行肝内门 -体静脉分流术时只要掌握了插管静脉的角度和深度仍具备和右侧穿刺途径一样多的优点     

Massive paradoxical air embolism in brain occurring after central venous catheterization: a case report

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.     

Cross-sectional internal diameters of human cervical and femoral blood vessels: relationship to subject's sex, age, body size

Cross-sectional internal diameter measurements were made of right and left common carotid and right femoral arteries and right and left internal jugular, superficial femoral, and common femoral veins in 32 normal human subjects utilizing duplex ultrasonography. The relationships of these vessel sizes to the subject's sex, age, height, weight, and body surface area were analyzed statistically; and graphs were constructed, indicating the relationship of blood vessel diameters to the various body size parameters. Findings indicate that 1) for the femoral veins, body surface area had the best correlation with the internal diameter of the vein; 2) for the right internal jugular vein, body weight had the best correlation with the internal diameter of the vein; 3) correlation between vein diameter and body size of the subject is better for the femoral veins than for the internal jugular veins; 4) internal diameter of the femoral and internal jugular veins increases about 20% when they are distended by 15 degrees of positional inclination of the subject's body; 5) neither age nor sex of the subject influences the positional distensibility of the veins examined; 6) the cross-sectional internal diameter of the femoral and internal jugular veins, as determined by duplex ultrasonography, closely relates to the external diameter of these vessels as measured by direct in vivo application of calipers and to the maximum outside diameter of cannula the vessel will accept.     

The relationship between the internal jugular vein and common carotid artery in the carotid sheath: the effects of age, gender and side

The internal jugular vein is often used for central venous catheter placement. The variations in the location of this vein along the major neck vessels (in the carotid sheath) may account for unsuccessful cannulations or iatrogenic arterial injuries. The aim of this study was to delineate the relation of the internal jugular vein and common carotid artery in the lower neck, and to assess the effects of age, gender and side on these anatomical structures. Two-dimensional ultrasonographic examinations of the right and left supraclavicular triangle were performed in 219 adult individuals who had no history of neck surgery or known pathology. The location of the internal jugular vein in relation to the common carotid artery was recorded. An anterolateral location of the internal jugular vein was the most common configuration observed on both sides (84% right side and 91.8% left side) followed by the lateral (14.2% right and 6.4% left) and anterior (1.4% right and 1.8% left) locations. A single case of a medial internal jugular vein was observed on the right side (0.23% of both sides). Subjects with a laterally located internal jugular vein were older than those with an anterolateral configuration (P<0.01). No gender differences were found with regard to these two configurations (P=0.867). The laterally located internal jugular vein was more frequent on right sides (P=0.007). Such information may be potentially useful for clinicians who are managing critically ill patients or patients undergoing hemodialysis.     

Brachiocephalic veins: an overlooked approach for central venous catheterization

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.     

A case of right partial and double internal jugular veins

We present a very rare case of right partial and double internal jugular veins, found in an 86-year-old Japanese female cadaver during a student dissection practice session in 2002 at Osaka Dental University. In this case, the right internal jugular vein separated into medial and lateral branches at a level with the middle of the fifth cervical vertebra. Both branches had the same thickness as an internal jugular vein and poured into the right subclavian vein. A slender venous space slit was formed by these two branches and the right subclavian vein. The inferior belly of the right omohyoid muscle and the inferior root of the right ansa cervicalis passed through the superior region in this venous space. To our knowledge, this case has never been reported previously. Therefore, we attempted to investigate the incidence based on existing references for similar cases and speculated on the development based on our findings. We considered the medial branch was the right internal jugular vein and the lateral branch was the communicating branch between the external and internal jugular veins.     

颈内静脉穿刺的有关解剖

对31例成人尸体右侧颈内静进行分段观测，颈内静脉上、下两段周围结构复杂。穿刺有一定危险，而中段较安全，为最佳的穿刺部位。     

Hepatic vein catheterization in the rat

A procedure for catheterization of a right hepatic vein is described in the rat. The procedure is based on the observation that, when the posterior half of the body is bent to the left, a right hepatic vein is aligned with the axis of anterior vena cava and posterior vena cava. A catheter, inserted in the right jugular vein and fitted with a rectilinear mandrel, is guided into the right auricle, the suprahepatic segment of posterior vena cava and a right hepatic vein. Successful catheterization of a right hepatic vein has been obtained in 47 out of 50 animals in which the procedure has been performed.