疑难危重患者超声引导下行颈内静脉置管效果观察

目的:观察超声引导对疑难危重患者行颈内静脉置管的效果。方法:选择需行颈内静脉穿刺留置导管的疑难危重患者60例,随机分为观察组和对照组各30例。观察组在超声引导下行颈内静脉穿刺置管,对照组凭体表解剖标志行颈内静脉穿刺置管。比较两组穿刺成功时间、穿刺次数、成功率、误伤动脉或胸膜、动静脉瘘、穿刺部位血肿、多次置管失败等并发症发生情况。结果:观察组穿刺成功时间(7±2)min,显著短于对照组的(16±10)min(P<0.05);一次穿刺成功率93.3%,非常显著高于对照组的30.0%(P<0.01)。观察组并发症发生率非常显著低于对照组(P<0.01)。结论:超声引导在疑难危重患者行颈内静脉置管的效果优于传统方法,穿刺时间短、一次穿刺成功率高、并发症少。     

前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管的临床应用

目的探讨前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管的可行性及其特点。方法选择需行中心静脉置管的患者120例,随机分为2组(n=60):实验组采用前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管,对照组采用颈内静脉穿刺置管。观察两组穿刺置管的总成功率、一次穿刺成功率、完成时间及并发症。结果试验组总成功率及一次穿刺成功率显著高于对照组(P<0.05或P<0.01),完成时间及并发症显著少于对照组(P<0.05)。结论前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管是一种高效、安全的中心静脉置管途径。     

超声引导改良婴幼儿颈内静脉穿刺置管术的临床研究

目的:探讨超声引导改良婴幼儿颈内静脉穿刺置管术的临床应用价值。材料和方法:随机抽取行先天性心脏病手术的婴幼儿60例分为2组(n=30)。A组:对照组,首选右颈内静脉中路,用20GY形穿刺针穿刺,再经Y型穿刺针置入J形引导钢丝,然后置入中心静脉导管。B组:实验组,在超声引导下用18GBD静脉外套管穿刺,经静脉外套管置入J形引导钢丝,然后置入中心静脉导管。记录两组穿刺置管总成功率、一次穿刺成功率、失败率及并发症。结果:B组总穿刺成功率高于A组(P<0.05),B组一次穿刺成功率显著高于A组(P<0.01),B组的穿刺并发症明显低于A组。结论:超声引导下经18G静脉留置针穿刺置管,大大提高了婴幼儿中心静脉置管的成功率,并降低了并发症的发生率,有很高的临床应用价值。     

颈外静脉与四肢静脉留置针在抢救危重病人中的效果比较

目的在抢救危重病人时为快速建立静脉输液通道,比较颈外静脉与四肢浅静脉留置针输液效果。方法203例危重病人,103例应用颈外静脉留置针穿刺术,100例应用四肢浅静脉留置针穿刺术,然后比较两者的穿刺所需时间、一次穿刺成功率、液体通畅良好度、液体最大流速、收缩压升高到80mmHg所需的平均时间、导管脱出、液体渗漏、置管保留时间及静脉炎发生率。结果颈外静脉组明显优于四肢浅静脉组,P<0.01。结论颈外静脉穿刺具有穿刺所需时间短、一次穿刺成功率高、液体通畅良好、液体流速快、收缩压回升到80mmHg所需的平均时间短、导管不易脱出、液体不易渗漏、置管保留时间长及静脉炎发生率低等优点。能为危重病人的抢救赢得时间。     

超声引导和盲穿法在颈内静脉穿刺置管术中的应用比较

颈内静脉穿刺置管传统采用体表可见或可触及的标志进行盲探式穿刺。随着其应用范围的不断扩大,临床常遇有肥胖、颈短、疤痕、血容量不足、静脉塌陷等意外,导致颈内静脉穿刺置管困难,传统的定位方法盲穿,一次成功率低.     

经颈外静脉行中心静脉置管80例

常规中心静脉穿刺置管的主要途径是颈内静脉、锁骨下静脉及股静脉。 1996～ 1998年 ,我院经颈外静脉穿刺置入中心静脉导管 80例 ,穿刺方法简化 ,减少了穿刺时的并发症。1　临床资料1 1　一般情况　 80例中 ,男 4 2例 ,女 38例 ;年龄 4～ 88岁 ,平均 4 5岁。右侧 4 2例 ,左侧 38例 ,导管留置时间 7～ 4 2ｄ。1 2　穿刺置管方法　病人仰卧 ,肩下垫薄枕 ,取头低足高位 ,头低 5°～ 10° ,选择颈外静脉较充盈的一侧 ,头偏向对侧 ,常规消毒 ,局麻或全麻下穿刺。若颈外静脉不充盈或充盈不明显时 ,可让病人深吸气后屏气 ,或在锁骨上缘压迫颈外静脉 …     

超声引导联合腔内心电图定位在中心静脉置管中的应用

目的：探讨超声引导联合腔内心电图定位技术在中心静脉置管中的应用价值。 方法：回顾性分析我院2016年1月至2018年6月行超声引导下颈内静脉穿刺并经腔内心电图定位的52例中心静脉置管患者的临床资料,观察首次穿刺成功率、一次性置管到位率及置管并发症情况。 结果：52例患者首次穿刺成功50例,首次穿刺成功率为96.2%,首次穿刺失败需2次穿刺并置管成功2例。所有患者穿刺过程未出现颈动脉误穿、血气胸、空气栓塞等并发症。52例患者经腔内心电图定位后行胸部X线检查,均证实导管头端位置理想,置管深度一次性到位率100%。2例患者在调整最佳置管深度过程中出现一过性心律失常,均得到及时纠正。 结论：超声引导下颈内静脉穿刺可明确血管有无变异,准确引导穿刺,减少并发症,提高置管成功率。同时,腔内心电图可实时提示置管深度,便于及时、准确指导导管头端位置调整。     

超声辅助血液透析临时血管通路建立的临床应用

目的探讨超声辅助下血液透析用中心静脉置管术的安全性和有效性,以及减少置管近期并发症的措施。方法回顾性分析成都军区总医院肾内科近9年的中心静脉置管术,统计使用盲穿、B超定位、B超引导三种方法穿刺颈内静脉、股静脉和颈外静脉的例数、一次成功率和发生并发症的种类及例数;人为从时间上划分为二个阶段,分别观察二阶段颈内静脉和股静脉穿刺的一次成功率和误穿动脉发生率,数据进行统计学分析。结果 866例中颈内静脉置管术617例,股静脉置管术245例,颈外静脉置管术4例;常规盲穿512例,其中一次成功421例（82.2%）,发生局部血肿10例（1.9%）,误穿动脉33例（6.4%）,伤及神经4例（0.8%）,皮下气肿1例（0.2%）;B超定位257例,其中一次成功238（92.6%）,发生血肿1例（0.4%）,误穿动脉2例（0.8%）,未发生其他并发症;B超引导97例,一次成功92例（94.8%）,未发生并发症;与常规盲穿比较,超声定位和引导穿刺的一次成功率明显提高（P〈0.01）,近期并发症的发生率明显降低;对比二阶段结果,第二阶段穿刺的一次成功率明显高于第一阶段（P〈0.01）,误穿动脉发生率明显低于第一阶段（P〈0.05）。结论血液透析用中心静脉置管术是一种风险较大的有创性操作,掌握正确的操作方法和采用超声辅助穿刺能有效降低风险,减少并发症,提高成功率。     

中心静脉通道的建立及其在临床中的应用

目的 倡导建立中心静脉通道的重要性,比较经右锁骨下静脉（TSCV）和右颈内静脉（TIJV）两种途径建立中心静脉通道的技术特点。方法 自1999年3月至2001年6月间共完成中心静脉通道植入术348例次,其中经右锁骨下静脉270例次,经右侧颈内静脉78例次;导管留置时间13－75d,平均23d。结果 TSCV组270次,268次成功,成功率99％。操作中和留置期间11例出现严重并发症,包括气胸2例,误留入锁骨下动脉1例,留置管阻塞3例,留置管进入右颈内静脉引起输液异常3例。穿刺口感染2例。TIJV组78次75次成功,成功率96％,严重并发症1次。结论 中心静脉通道在临床上具有很大的实用价值,其成功率与操作者解剖知识及技术熟练程度有关。     

超声引导经腋静脉穿刺中心静脉置管的临床应用

目的 探讨应用超声引导经腋静脉穿刺中心静脉置管的安全性和有效性。资料与方法 回顾性选取2019年4月—2021年3月东莞光华医院实施中心静脉置管的180例患者,根据治疗方法分为锁骨下静脉穿刺组、超声引导下颈内静脉穿刺组和超声引导下腋静脉穿刺组,每组60例。超声检测锁骨下静脉穿刺组和超声引导下腋静脉穿刺组穿刺静脉深度、静脉直径、静脉与动脉间的距离、穿刺点与胸膜间的距离。记录3组患者一次穿刺成功率。比较3组患者感染、血栓、气胸、误穿动脉等并发症发生率。结果 超声引导下腋静脉穿刺组与锁骨下静脉穿刺组锁骨中线处静脉直径和深度差异无统计学意义(t=1.098,P=0.274;t=-1.886,P=0.064);超声引导下腋静脉穿刺组静脉与动脉的距离、与胸膜间的距离均大于锁骨下静脉穿刺组,差异有统计学意义(t=-11.993,P=0.000;t=-19.131,P=0.000);超声引导下颈内静脉穿刺组和超声引导下腋静脉穿刺组一次穿刺成功率均高于锁骨下静脉穿刺组,差异有统计学意义(χ²=6.988,P=0.008;χ²=5.175,P=0.024);超声...     

婴幼儿超声辅助下颈内静脉穿刺植入完全植入式静脉输液港评价

目的 探讨超声辅助下颈内静脉穿刺在婴幼儿完全植入式静脉输液港(TIVAP)植入术中的效果.方法 回顾性分析2009年1月至2016年7月在上海交通大学医学院附属儿童医学中心(单中心)治疗的446例TIVAP植入术患儿临床资料,患儿平均年龄1.3岁(4个月～2.8岁).比较传统颈内静脉盲穿刺和超声辅助下颈内静脉穿刺耗时、一次穿刺成功率、穿刺并发症发生率,并作统计学分析.结果 446例患儿中颈内静脉盲穿刺265例,平均需时7.6 min,一次穿刺成功201例(75.85％),发生穿刺并发症15例(5.66％);超声辅助下颈内静脉穿刺181例,平均需时4.2 min,一次穿刺成功176例(97.24％),发生穿刺并发症3例(1.70％).结论 婴幼儿TIVAP植入术时采用超声辅助下颈内静脉穿刺,可缩短手术时间,提高一次穿刺成功率并减少穿刺并发症发生,是一种安全有效、简单可行的技术,值得临床推广.     

Tunneled jugular small-bore central catheters as an alternative to peripherally inserted central catheters for intermediate-term venous access in patients with hemodialysis and chronic renal insufficiency.

In 34 patients with chronic renal insufficiency or failure, 43 small-bore central catheters were placed via the internal or external jugular veins: right internal jugular vein, 28; left internal jugular vein, 14; right external jugular vein, one. Central venous access was achieved in all patients (mean catheter dwell time, 28 days; range, 3-99 days), with two minor complications (arterial puncture and catheter damage during suturing). Tunneled jugular small-bore central catheters are a vein-preserving alternative to peripherally inserted central catheters in this population.     

经右颈内静脉球囊飘浮电极导管床旁快速心脏起搏25例

目的　探讨床旁快速起搏的方法。方法　采用Seldinger法穿刺右颈内静脉经鞘管插入顶端球囊飘浮电极导管直至右室起搏。结果　共2 5例在床旁无X线指引下迅速达到有效起搏,插入时间为5 10min(平均8min)。结论　采用Seldinger法穿刺右颈内静脉,沿鞘管送入顶端球囊飘浮电极导管,可在床边不需X线指引,安全快速地进行右心室起搏     

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

Objective

To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein.

Materials and Methods

We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records.

Results

A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively).

Conclusion

Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.     

Internal jugular venous valves in children: high-resolution US findings

The aim of this study was to determine in children the prevalence rate and to describe the sonographic morphology of the valves in the internal jugular veins. One hundred twenty children (60 boys and 60 girls; mean age ± SD 10 ± 4 years, age range 3–20 years) were recruited for the study. They underwent sonographic examination of both internal jugular veins. The number of valvular cusps, the length of the cusps and exact site of origin were recorded. In 96 % of the children a valve was found in one or both internal jugular veins. Within this group a valve was detected unilaterally in 26 % and bilaterally in 74 % of the cases. Ultrasound morphological and morphometric analysis was carried out in a total of 239 internal jugular veins; 200 (84 %) veins were found to have valves. The origin of the cusps was located at a mean distance of 9 mm (0–26 mm) proximal to the confluence of the subclavian and internal jugular veins into the brachiocephalic vein. A valve in the distal part of the internal jugular vein is a very common finding with characteristic features on US. Received: 7 June 2000 Revised: 24 July 2000 Accepted: 25 July 2000     

Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients

Purpose: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients.

Material and Methods: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n = 40) were compared with those of the anatomical landmark method (n = 40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared.

Results: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2.

Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.     

Hemopericardium resulting from attempted internal jugular vein catheterization: A case report and review of complications of central venous catheterization

An unusual case of hemopericardium and presumed fatal cardiac tamponade complicating attempted right internal jugular vein catheterization by the posterior approach is reported. Reports of complications in a series of internal jugular vein catheterizations using various approaches (posterior, central, anterior, supraclavicular) and subclavian vein catheterizations are reviewed. Internal jugular vein catheterization is not necessarily safer than subclavian vein catheterization: numerous factors determine success rate and complication rate in central venous catheterizations.