锁骨上途径行锁骨下静脉穿刺286例次分析

锁骨下静脉穿刺在临床危重病人的抢救中有重要意义。Ａｕｂａｎｉａｃ等率先提出锁骨下途径行锁骨下静脉穿刺,得到广泛应用。现临床上多为使用这一传统的锁骨下静脉穿刺法。此后Ｙｏｆｆａ提出采用锁骨上途径进行锁骨下静脉穿刺,认为优于锁骨下法[1]。我们自1995年采用锁骨上穿刺法以来,取得了较好的效果,现总结如下。1　资料与方法11　一般资料　本组共286例次,其中男201例次,女85例次,年龄25～91岁,平均607岁。均因各种急危重症,临床需要测定中心静脉压(ＣＶＰ),维持静脉输液通路等而行锁骨下静脉穿刺。12　方法　穿刺时患者取平卧位,头转…     

锁骨下静脉穿刺置管术的护理

锁骨下静脉穿刺置管术因其部位开放，固定，血流量充足，置管后活动不受限制，我科2004年8月-2006年2月，对长期输液而周围静脉不易穿刺者，特殊的抗肿瘤药物的静点（因其药物刺激可形成静脉炎）的60例病人采用锁骨下静脉穿刺作为病人住院期间的静脉通路，很大程度上减轻了病人反复穿刺的痛苦，保证了治疗药物的顺利进行，临床使用方便，实用，深受病人和家属的认可，下面就锁骨下静脉穿刺置管术的护理谈几点体会。     

提高锁骨下静脉穿刺成功率的方法

目的提高锁骨下静脉穿刺置管的成功率。方法穿刺点为锁骨中点下缘下方约1 cm,再偏外侧1 cm 处,即锁骨下缘中1/3交界处,穿刺方向指向胸锁乳突肌胸骨头与锁骨形成的夹角平分线上1cm处,穿刺针头进入锁骨下后把肩膀、针栓同时往下压,使针尖向上,且进针行针紧贴锁骨进行。结果 83例患者中一次性穿刺成功78例,占 93．98％,误入动脉3例,占3．61％,穿刺失败2例,占2．41％,未发生气胸并发症。结论改进后的锁骨下静脉穿刺方法,提高了穿刺的成功率,减少了并发症的发生,效果良好。     

锁骨下静脉穿刺置管术误入颈内静脉的分析与护理对策

目的探讨锁骨下静脉穿刺置管术误入颈内静脉的原因与护理对策。方法将169例锁骨下静脉插管的患者按不同的插管方法进行分组：试验组（78例）和对照组（9l例），对照组按常规的插管方法进行插管，试验组在常规的操作方法上进行了改进。对两组患者的插管误入率进行比较。结果试验组明显优于对照组（P〈0．05），置管时间平均延长27．3天。结论通过对锁骨下静脉置管进行操作方法的改进，减少了误入颈内静脉的发生率，有助于提高患者的生存质量。     

老年人经锁骨上途径行锁骨下静脉穿刺278例次报道

我们自 1995年初开始 ,在老年患者中采用经锁骨上途径行锁骨下静脉穿刺 ,取得良好的临床效果 ,现总结报道如下。1　资料与方法1 1　一般资料　所有患者均为住院病人 ,分成老年组与非老年对照组。老年组共 2 78例次 ,男 2 0 5例次 ,女 73例次 ,年龄 6 0～ 91岁 ,平均 6 9 9岁。对照组为非老年患者 ,共 113例次 ,男 82例次 ,女 31例次 ,年龄 15～ 5 9岁 ,平均 5 8 1岁。1 2　穿刺适应证　所有患者均因各种急危重症需建立通畅的静脉通路 ,测量中心静脉压等而行深静脉穿刺。其中老年组 198例次还因胸闷、气促、心动过速等循环症状 ,急需鉴别心功…     

锁骨下静脉穿刺输液术

锁骨下静脉穿刺输液术（河南省新乡市中心医院４５３０００）孙玉琴，张学芬锁骨下静脉穿刺输液是通过锁骨下静脉穿刺留置硅胶管进行深部静脉输液的一种治疗技术，５０年代开始虽有人报导，由于受当时医疗设备和操作条件的限制未能引起重视和推广。随着医学科技的发展。８...     

锁骨下静脉穿刺并发症原因分析

锁骨下静脉穿刺术因减少病人多次浅静脉穿刺痛苦，临床操作方便，护理便利，液体不外渗，不易感染，容易固定等优点受到病人的欢迎和医护人员的重视，是目前临床上应用较为广泛的输液途径。但锁骨下静脉穿刺并发症的发生给病人带来身体上的痛苦和经济负担。现将锁骨下静脉穿刺并发症原因及护理介绍如下。     

临床护理路径在经腋静脉穿刺螺旋电极行永久心脏起搏器植入术患者中的应用

目的探讨临床护理路径在经腋静脉穿刺螺旋电极行永久心脏起搏器植入术患者中的应用效果。方法采用便利抽样法,选择2018年1—12月在湖州市中心医院行经腋静脉穿刺螺旋电极行永久心脏起搏器植入术患者217例为研究对象。根据患者入院时间,将2018年1—6月入院患者102例作为对照组,2018年7—12月入院患者115例作为观察组。对照组采取常规护理,观察组按照拟定的临床路径护理,比较两组患者住院时间、住院费用、健康知识掌握程度和患者满意度。结果观察组患者住院时间(12.63±2.39)d,住院费用(1.62±0.37)万元,均低于对照组,差异有统计学意义(t值分别为4.455,3.681;P<0.05)。观察者患者健康知识得分为(92.37±5.28)分,高于对照组,差异有统计学意义(t=8.886,P<0.05)。观察组患者对护理满意度93.04%,对照组为81.37%,差异有统计学意义(χ^2=6.759,P<0.05)。结论临床护理路径在经腋静脉穿刺螺旋电极行永久心脏起搏术中应用,可有效促进患者术后康复,减少医疗成本,提高患者对护理满意度,值得临床推广运用。     

Percutaneous cephalic vein approach for permanent pacemaker implantation

Implantation of permanent pacemaker leads into the cephalic vein within the deltopectoral groove is enhanced by introduction of a flexible guidewire into the brachial vein at the antecubital fossa, which is then advanced to the subclavian vein. The cephalic vein within the deltopectoral groove is easily found by incision with the guidewire as a marker. A pacing lead or leads can be inserted along the guidewire or by using a sheath advanced over the guidewire. The procedure was performed on 32 patients and the pacing leads of 28 procedures (DDD 15, VDD 9 and WI 4) were inserted using the cephalic vein without complications.     

锁骨下静脉穿刺后置管过程中常见问题及处理

目的探讨锁骨下静脉穿刺（锁穿）成功至置管成功过程中的常见问题与处理对策。方法回顾分析572例锁穿病人置管过程中所遇到的问题与解决方案。结果置管过程中常见有导丝插入困难,导丝进入颈内静脉,导管放置困难,导丝拨出困难,出血和心律失常等。经过相应处理仅4穿刺失败,总穿刺成功率99．3％。结论遇到问题时要认真分析原因,规范操作。良好的心态和熟练的技术是成功的关键。     

Ultrasound-guided puncture of the subclavian vein

The localisation of arteries or veins is facilitated by the use of an ultrasound Doppler unit. This method has proved particularly valuable when dealing with deep lying vessels which are neither visible nor palpable. Until recently, such vessels had to be punctured blindly. This technique employs the Doppler ultrasound-method, which is especially used in the diagnosis of diseases of the peripheral vessels. These also are not only useful for the localisation but also to assist the puncture of the vessel.     

Acute subclavian or axillary vein occlusion during biventricular pacemaker implantation

During biventricular pacemaker implantation, multiple punctures of the subclavian vein were performed and venous occlusion was apparent during the procedure, which in one case was stopped before lead insertion and in the other patient new access has to be forced through the occlusion by removing one of the already implanted leads. For implanting physicians, it is important to know that acute venous occlusion may occur during lead implantation.     

Ultrasonographic predictors of unsuccessful cephalic vein approach during pacemaker or defibrillator lead implantation

BACKGROUND: The cephalic vein approach is a preferred route for endocardial lead implantation; however, it is associated with a significant failure rate. Anatomic abnormalities likely play an important role, but specific features have not been well characterized. METHODS: Color Doppler ultrasonography was performed in 82 consecutive patients prior to endocardial lead implantation. Venous diameter, depth, flow velocity, and morphology were evaluated and comparisons made between the successful and failed implantations at various stages of the procedure. RESULTS: Endocardial lead implantation was unsuccessful in 14 patients (17%), with eight patients of venous isolation failure, 4 patients of cannulation failure, and 2 patients of guidewire crossing failure. Venous diameter was found to be the only independent predictor for isolation and implantation failure. The best cutoff value of cephalic venous diameter to predict unsuccessful cephalic venous approach was < or = 2.2 mm. In total, there were 10 patients with extensive cephalic vein tortuosity. In seven of these 10 patients, the incidence of standard guidewire crossing failure was significantly higher than that without a tortuous cephalic vein (7/10 vs 6/60, P < 0.001). After switching to a hydrophilic guidewire, crossing and navigation were successful in five of the seven patients. CONCLUSIONS: Color Doppler imaging is useful to identify cephalic vein characteristics. A small venous diameter is the ultrasonographic predictor for failure of cephalic vein approach. A tortuous venous morphology is associated with a high incidence of guidewire crossing failure, which can be mostly overcome by using a hydrophilic guidewire.     

Preclavicular route following cephalic venous cutdown for pacemaker or defibrillator lead implantation

Following cephalic venous cutdown, an unexpected preclavicular course was used in two cases for a pacemaker and a defibrillator lead implantation. This very rare anomaly was documented by cephalic venogram but did not cause any significant intraoperative difficulty during single lead implantation.     

2种途径深静脉穿刺中心静脉置管的Meta分析

目的 比较颈内静脉(IJV)与锁骨下静脉(SV)穿刺中心静脉置管部分并发症发生率.方法 收集有关IJV与SV穿刺中心静脉置管的临床对照研究,根据纳入标准纳入文献.对纳入文献进行Meta分析并对结果行敏感性分析.结果 纳入18篇文献. Meta分析结果提示IJV与SV穿刺中心静脉置管导管相关性感染率差异有统计学意义[RR=1.74,95%CI(1.32,2.30)],误入动脉率差异有统计学意义[RR=3.19,95%CI(1.70,5.99)],一次穿刺成功率差异无统计学意义[RR=1.06,95%CI(0.90,1.24)].结论 IJV穿刺中心静脉置管导管相关性感染率及误入动脉率高于SV穿刺;尚不能认为2组一次穿刺成功率有差别;本结果仍需要高质量的随机对照试验来评价.     

Recurrent pacemaker lead induced axillary subclavian vein thrombosis

This report describes a patient with two recurrences of axillary subclavian vein thrombosis more than 1 year after implantation of a permanent transvenous pacemaker. Both recurrences were successfully treated with local thrombolysis.     

A cosmetic approach for pectoral pacemaker implantation in young girls

Pectoral placement of pacemaker generators, combined with use of a redundant intravascular lead portion, reduces the need for endocardial lead advancement during growth in children. While the use of small generators and submuscular pockets has contributed to cosmetic acceptability, the conventional subclavicular incision may occasionally form a keloid scar that is unacceptable in young girls. A modified implantation technique was used in five girls (age 2.6-13.3 years) during implantation of VDD (n = 2), VVIR (n = 2), and DDDR (n = 1) pacemakers. A 5-cm incision was made in the axilla along the line of the pectoralis major and dissection was continued below the muscle to create a pocket for the generator. Subclavian vein puncture was performed from the axillary incision and beneath the pectoralis major muscle using standard or extra long needles with a needle guard. Peel away sheaths were used for lead positioning. The generator was placed in the submuscular pocket and the wound closed with absorbable sutures. At follow-up, pacemaker function was excellent and neither the scars nor pacemakers were visible from the front. In conclusion, the axillary incision with direct subclavian vein puncture from below the pectoralis major muscle offers the advantages of pectoral pacemaker implantation through a single cosmetic incision.