超声引导下经皮右颈内静脉穿刺中心静脉置管术35例体会

目的总结超声引导下经皮右颈内静脉穿刺中心静脉置管术的体会。方法将70例拟行经皮右颈内静脉穿刺中心静脉置管术的患者随机分为2组,每组35例。观察组在超声引导下置管,对照组行传统体表定位穿刺置管。观察2组穿刺置管成功率、完成穿刺置管操作时间及误穿动脉、血肿形成和引起气胸等并发症发生率。结果观察组一次性和总穿刺置管成功率均高于对照组,穿刺置管操作时间短于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论超声引导下经皮右颈内静脉穿刺中心静脉置管术,成功率高,并发症少,安全性高。     

高频彩色多普勒超声引导直视下右颈内静脉穿刺置管术

目的评估高频彩色多普勒超声引导直视下右颈内静脉穿刺置管术的应用效果。方法在高频彩色多普勒超声实时引导及监测下,对64例尿毒症患者行右颈内静脉双腔导管置入术,将其分为直视组（36例）和对照组（28例,带穿刺架）,对比两组的穿刺效果。结果试验组与对照组一次成功率分别为94.44%和96.43%（P〉0.05,差异无统计学意义）。所有患者未出现误穿颈动脉、气胸等并发症。结论高频彩色多普勒超声引导直视下行右颈内静脉穿刺置管术安全、简便、有效。     

超声定位与实时引导右颈内静脉穿刺置管用于急诊血液透析的价值

目的：通过与体表解剖法比较、探讨术前超声定位与术中动态引导右颈内静脉穿刺置管用于急诊血液透析患者的价值。方法：拟行急诊血液透析患者90例,ASAⅡ～Ⅳ级,随机分为3组,（n=30）,所有患者均去枕平卧,头左偏30°体位,于环状软骨平面穿刺。A组：体表解剖法组,依据体表解剖标志定位,行右颈内静脉中路法穿刺置管。B组：超声定位组,术前超声定位,并标记右颈内静脉,穿刺置管。C组：超声动态引导组,使用便携式彩超定位,全程引导右颈内静脉穿刺置管。分别记录穿刺次数及一次穿刺成功率,操作时间,早期穿刺并发症等情况。结果：C组1例失败,B组有2例失败,A组5例失败。与A组比较,C组穿刺次数少（P〈0.05）,一次穿刺成功率、一次置管成功率高（P〈0.01）,无误穿动脉（P〈0.05）,但穿刺时间最长（P〈0.05）。与B组比较,C组操作时间更长（P〈0.05）。结论：急诊血液透析患者右颈内静脉穿刺前常规超声定位,有利于提高一次穿刺置管成功率,缩短穿刺时间,减少并发症发生。对于解剖变异或穿刺困难者宜采用超声实时引导。     

护理干预对喉癌术后患者生存质量的影响

目的 探讨颈内静脉、锁骨下静脉穿刺中心静脉置管术的临床应用效果。方法 将89例行中心静脉置管术的患者随机分为锁穿组（41例）和颈穿组（48例），颈穿组行颈内静脉穿刺置管．锁穿组行锁骨下静脉穿刺王管。观察两组一次置管成功率厦并发症的发生情况。结果 两组一次置管成功率厦并发症发生率比较。差异有显著性意义（P〈0．01，P〈0．05）。结论 颈内静脉穿刺应作为中心静脉置管的首选路径。     

体表定位穿刺失败后行超声引导下颈内静脉置管23例分析

目的 分析深静脉置管建立血液透析血管通路时,应用超声引导的时机、准确性、成功率,可能出现的并发症.方法 回顾统计2006年8月至2008年11月行颈内静脉穿刺置管建立血液透析血管通路的450例患者,探讨超声介入的时机,寻找体表定位穿刺失败的原因.分析影响穿刺成功率、并发症发生与血流量的因素.结果 共计穿刺450例患者,其中23例常规体表定位穿刺失败,占5.1%;失败者在超声引导下穿刺成功22例,改股静脉置管1例.超声检查发现体表定位穿刺失败的原因包括:①右颈内静脉缺如;②右颈内静脉位置变异:靠外、靠上、靠下,以靠外侧多见,占34.7%,1例位置较深;③重症患者因体位不合适导致穿刺不成功者占21.7%.结论 超声引导下进行颈内静脉穿刺置管简便易行,其临床普及应用可提高穿刺成功率,降低并发症.     

颈内、锁骨下静脉穿刺置管术的比较

目的探讨颈内静脉、锁骨下静脉穿刺中心静脉置管术的临床应用效果.方法将89例行中心静脉置管术的患者随机分为锁穿组(41例)和颈穿组(48例),颈穿组行颈内静脉穿刺置管,锁穿组行锁骨下静脉穿刺置管.观察两组一次置管成功率及并发症的发生情况.结果两组一次置管成功率及并发症发生率比较,差异有显著性意义(P＜0.01,P＜0.05).结论颈内静脉穿刺应作为中心静脉置管的首选路径.     

超声引导下颈内静脉置管在婴儿心脏手术中的应用

目的 探讨超声引导下颈内静脉置管术在婴儿心脏手术中的临床应用.方法 选择年龄30d～1岁,体重3.70～12.0 kg行先天性心脏病手术的患儿40例,随机均分为两组.观察组(A组)在超声引导下将颈内静脉置于屏幕中央,用18G BD静脉留置针穿刺血管,置静脉外套管后,放入引导钢丝,然后置入中心静脉导管;对照组(B组)选择右颈内静脉中路或后路,用18G BD静脉留置针穿刺,回血通畅后经静脉外套管置入引导钢丝,最后置入中心静脉导管.记录两组穿刺置管时间、穿刺总成功率、一次穿刺成功率、失败率及并发症.结果 A组穿刺置管时间明显短于B组(P＜0.05).A组穿刺总成功率100%,明显高于B组的80%(P＜0.05);A组一次穿刺成功率90%,显著高于B组的65%(P＜0.01);A组无失败病例,B组失败率20%;A组的穿刺并发症低于B组,但差异无统计学意义.结论 超声引导下婴儿颈内静脉穿刺置管,提高了成功率,能有效降低并发症,并缩短穿刺置管时间,有较高的临床应用价值.     

超声引导下颈内静脉置管的临床观察

目的观察超声引导对颈内静脉置管成功率及并发症的影响。方法选择2010年1月至2012年12月间需行颈内静脉置管进行血液透析治疗的患者366例,随机分为2组,即超声引导组与对照组。超声引导组（188例）在超声引导下行颈内静脉置管,对照组（178例）根据体表标记盲探下行颈内静脉置管,比较2组之间的穿刺成功率及并发症情况。结果超声引导组188例患者全部穿刺成功,置管成功率为100％（188／188）;对照组178例患者中有5例置管失败,置管成功率为97．1％（173／178）,2组比较差异有统计学意义（P〈0．05）。其中超声引导组有181例（占96．2％）患者一针穿刺成功,对照组有95例（占53．3％）患者一针穿刺成功,2组比较差异有统计学意义（P〈0．01）。超声引导组无一例患者发生误伤动脉、血肿、假性动脉瘤及气胸,对照组有12例患者误伤动脉,5例发生血肿,1例出现假性动脉瘤,无患者发生气胸。结论超声引导可提高颈内静脉置管成功率,减少穿刺次数及并发症的发生,值得临床推广应用。     

超声引导下颈内静脉置管在新生儿手术中的应用

<正>颈内静脉穿剌置管已被广泛应用于危重新生儿,是抢救时快速扩容、中心静脉压力测定、血流动力学监测、肠外营养、血液置换及介入治疗的有效途径~([1])。根据新生儿解剖和生理学特点,目前采用的经皮盲穿的方法放置导管,穿刺难度大,置管失败率高,并发症多。我院近年来采用超声引导下行新生儿颈内静脉置管,提高新生儿颈内静脉穿剌置管成功率和安全性,取得了较好的临床效果,现报道如下。     

超声导引下颈内静脉置管的效果观察

目的探讨超声引导下颈内静脉穿刺置入中心静脉导管（CVC）的应用效果。方法将CVC置管的患者按入院先后分为对照组和超声组,对照组112例行常规CVC置管,超声组128例在超声导引下行CVC置管。比较两组患者的一次穿刺成功率、总置管成功率、穿刺时相关并发症（误穿动脉、血肿、臂丛神经异感、气胸血胸、交感神经损伤）的发生情况以及患者的满意度、舒适度。结果超声组患者一次穿刺成功率为92.19%,置管总成功率为100%,穿刺时误穿动脉、血肿、臂丛神经异感等并发症的发生率为0;对照组患者一次穿刺成功率为80.36%,置管总成功率为92.86%,穿刺时误穿动脉、血肿、臂丛神经异感等并发症的发生率分别为6.25%、8.92%、5.36%;超声组患者满意度和舒适度分别为90.63%、84.38%,对照组67.85%、51.79%。两组相比,差异均有统计学意义（均P〈0.05）。结论与常规CVC置管相比,超声导引下颈内静脉置管成功率高,患者置管时并发症少,提高了患者满意度和舒适度。     

Correção endovascular de lesão de artéria subclávia secundária à cateterismo de veia jugular interna: relato de caso

Background and objectivesUltrasound‐guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life‐threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm.Case reportWe describe a case of the successful endovascular repair of right subclavian artery injury in a 75‐year‐old woman. Subclavian artery was injured secondary to ultrasound‐guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery.ConclusionUnder general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.     

超声引导下经颈内静脉植入静脉输液泵1856例体会

【摘要】〓目的〓探讨超声引导下颈内静脉植入式静脉输液泵植入手术方法。方法〓回顾性分析中山大学孙逸仙纪念医院乳腺肿瘤医学部从2011年1月至2014年3月期间1856例超声引导下颈内静脉输液港植入手术的资料。结果〓1856例患者超声引导下经颈内静脉植入成功率100%。其中经右侧颈内静脉植入1838例(占99.03%),经左侧颈内静脉植入18例(占0.97%)。发生置管术中并发症6例(0.3%);发生术后使用输液港过程中并发症25例(1.3%),无死亡病例。结论〓植入式输液泵在超声引导下行颈内静脉植入成功率很高,并发症发生率比较低,且多不是严重并发症。     

Internal jugular vein cannulation guided by ultrasonography in pediatric patients undergoing cardiovascular surgery

BACKGROUND: Central venous catheterization is essential for the anesthetic management of operations for congenital heart diseases. We prospectively examined the usefulness of ultrasonography in internal jugular vein catheterization in infants. METHODS: Internal jugular vein cannulation was guided using an ultrasound image scanner in 96 pediatric cardiac patients. We investigated the rate of successful catheterizations, the number of attempts, the time from venipuncture to wire insertion, and the laterality of internal jugular vein diameters. RESULTS: The success rate in all 96 patients was 95.8% with no carotid artery puncture. Patients younger than 12 month of age had success rates of 90%. In patients younger than 1 month of age and with weights less than 3.4 kg, the success rate was 76.9%. The time from venipuncture to proper wire insertion in the first attempt (55.2%) was 50.8+/-18.9s; 157.3 +/-56.4s for second attempt (18.8%) ; 285.7+/-165.7s for third attempt (7.6%) ; 346.0+/-98.4s for fourth attempt (5.5%) : and 510.0+/-98.4s for fifth attempt (2.1%). The time requited was 1404.5+/-518.4s for attempts that required more than seven passes. Cannulations in four cases were unsuccessful because the image of the internal jugular vein was difficult to visualize. The left internal jugular vein diameter was larger than the right in 40 cases. In three unsuccessful cases, the diameter was less than 4.5 mm. CONCLUSIONS: Internal jugular vein cannulation guided by ultrasonography can be performed safely and quickly in pediatric patients.     

Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients

OBJECTIVE: To investigate whether prepuncture ultrasound evaluation of vascular anatomy facilitates internal jugular vein cannulation compared with landmark-guided puncture. DESIGN: Prospective randomized study. SETTING: Single community hospital. PARTICIPANTS: Adult patients undergoing general anesthesia (n = 240). INTERVENTIONS: The right internal jugular vein was cannulated using either anatomic landmarks or prepuncture ultrasound (3.75/7.5 MHz) guidance. In the landmark group, respiratory jugular venodilation was used as the primary landmark for locating the vein. Results of cannulation and the incidence of complications were compared. MEASUREMENTS AND MAIN RESULTS: Patients were randomly assigned to the ultrasound or landmark group. Respiratory jugular venodilation was identified in 188 patients (78.3%), in whom results of cannulation did not differ between the 2 techniques with respect to the venous access rate (cannulated at the first attempt: 83.5% in the landmark v 85.7% in the ultrasound group), the success rate (cannulated within 3 attempts: 96.9% v 95.6%), and the incidence of arterial puncture (1.0% v 3.3%). In the remaining 52 respiratory jugular venodilation-unidentified patients, the access rate (30.4% v 86.2%, p < 0.001) and the success rate (78.3 v 100%, p < 0.05) were significantly better in the ultrasound group, and no arterial puncture was recorded in the ultrasound group, whereas the incidence was 13.0% in the landmark group. The results were similar regardless of the ultrasound frequency used. CONCLUSION: Prepuncture ultrasound evaluation did not improve the result of right internal jugular vein cannulation compared with the respiratory jugular venodilation-guided approach. When the landmark was not observed, however, the prepuncture ultrasound guidance was helpful in facilitating the cannulation.     

A randomized trial of ultrasound image-based skin surface marking versus real-time ultrasound-guided internal jugular vein catheterization in infants

BACKGROUND: Ultrasound-guided central venous catheterization has been recommended to increase the procedural success rate and enhance patient safety. However, few studies have examined the potential advantages of one ultrasound technique with another, specifically in small infants. METHODS: The authors randomly assigned 60 neonates and infants weighing less than 7.5 kg to an ultrasound-guided skin-marking method (n = 27) versus real-time ultrasound-assisted internal jugular venous catheterization (n = 33). The times to successful puncture of the internal jugular vein and to catheterization were measured. Attempts at needle punctures for successful catheterization were counted. Procedural complications were recorded. RESULTS: In the real-time group, compared with the skin- marking group, venous puncture was completed faster (P = 0.03), the time required to catheterize was shorter (P < 0.01), and fewer needle passes were needed. Specifically, fewer than three attempts at puncture were made in 100% of patients in the real-time group, versus 74% of patients in the skin-marking group (P < 0.01). A hematoma and an arterial puncture occurred in one patient each in the skin-marking group. CONCLUSIONS: The real-time ultrasound guidance method could enhance procedural efficacy and safety of internal jugular catheterization in neonates and infants.     

超声穿刺架引导下颈内静脉置管124例

目的：探讨超声穿刺架引导在颈内静脉置管中的作用。方法 124例患者在超声穿刺架引导下沿颈内静脉置入三腔或单腔中心静脉导管。结果 124例患者均一次性置管成功,成功率为100％,且无明确并发症。结论 超声技术与穿刺架引导的结合使得颈内静脉置管变得安全、方便、快捷,大大减少了并发症和穿刺失败的发生率。     

A Prospective Randomized Study to Compare Ultrasound-Guided with Nonultrasound-Guided Double Lumen Internal Jugular Catheter Insertion as a Temporary Hemodialysis Access

Internal jugular venous catheters (IJVC) for hemodialysis are a commonly employed temporary vascular access for hemodialysis. Most hospitals still follow the use of blind technique, which uses anatomical landmarks. Even in the most experienced hands this procedure has a variable success rate. Ultrasound guidance can decrease the incidence of periprocedural complications and improve the success rate. In this randomized study we compared the procedure success rate and periprocedural complications in patients undergoing ultrasound guided vs. nonultrasound guided IJVC insertion for a temporary hemodialysis access. Methods. All patients subjected to insertion of an IJVC between March 2004 and June 2004 were enrolled into the study, randomized to either the blind (group A) or ultrasound guided (group B) procedure, which uses a portable ordinary ultrasound machine without a needle guide. The aseptic Saldinger technique was used for catheterization in both the groups. Baseline characteristics of patient and periprocedural events were recorded. Results. A total of 60 patients were randomized, 30 patients each in two groups. First attempt venous cannulation success rate was 56.7% in group A compared to 86.7% in group B. Chance of occurrence of adverse outcome was significantly more in the blind procedure (P = 0.020). A post-procedure chest radiograph done in all patient showed no complications. Conclusion. Ultrasound guided procedure for internal jugular vein catheter insertion using an ordinary ultrasound machine was significantly safer and more successful as compared to the blind technique.