颈外静脉留置针的临床应用

目的探讨颈外静脉留置针的临床应用,以减轻患者痛苦,保护血管和维护稳定的静脉输液。方法对106例患者通过颈外静脉留置套管针输液观察穿刺部位及输液情况。结果留置套管针输液3~9 d,未发现局部或全身感染等症状。结论穿刺前做好解释工作,能得到患者的积极配合;正确选择穿刺部位,术中严格无菌操作,掌握置管时间和熟练的操作技术是颈外静脉留置针的关键环节;置管期间,精心护理病人及置管部位,对保证输液顺利具有重要作用。     

颈外静脉留置针穿刺置管在危重患者抢救中的应用

目的:提高危重患者静脉输液质量。方法:将200例危重患者随机分为观察组和对照组各100例。采用22G静脉留置针,观察组行颈外静脉穿刺置管,对照组行四肢浅表静脉穿刺置管。观察两组留置针穿刺效果和留置效果。结果:观察组一次穿刺成功率及留置时间显著高于对照组(均P<0.01),静脉置管异常情况发生率显著低于对照组(P<0.01)。结论:应用颈外静脉留置针穿刺置管能有效提高危重患者静脉输液护理质量,有利于患者的救治。     

颈外静脉穿刺行中心静脉置管80例

目的通过对颈外静脉穿刺置管与颈内静脉穿刺置管进行比较,探讨中心静脉置管的最佳途径。方法对160例病人中心静脉置管,病人随机分为两组,分别行颈外静脉穿刺置管与颈内静脉穿刺置管,记录总成功率、一次成功率、并发症发生率、穿刺完成时间。结果采用颈外静脉穿刺置管较颈内静脉穿刺一次进针成功率高,且完成时间短。结论颈外静脉穿刺置管具有操作简便、一次穿刺成功率高、完成时间短、并发症少等优点,与颈内静脉穿刺置管比较,它是一种安全实用的中心静脉置管方法。     

锁骨下静脉穿刺置管在普外科的应用（附526例报告）

锁骨下静脉穿刺置管在普外科已被广泛应用于快速输血输液、肿瘤化疗、静脉营养、中心静脉压测定等方面，它具有操作快捷、容易固定、护理便利、不易感染等优点，减轻了患者因反复穿刺所带来的痛苦，有利于患皆术后活动，便于危重患者的抢救用药，同时也减轻了护士的劳动强度。     

颈外静脉留置针通道在上消化道大出血患者输液中的应用

目的 提高上消化道大出血患者静脉输液护理质量.方法 将64例上消化道大出血患者随机分为观察组和对照组各32例.采用22 G静脉留置针,观察组行颈外静脉穿刺置管.对照组行前臂静脉穿刺置管.观察两组留置针穿刺效果和留置效果.结果 观察组一次穿刺成功率及经留置针采血成功率显著高于对照组(均P＜0.01),穿刺时间显著短于对照组(P＜0.01),留置时间显著长于对照组(P＜0.01),外渗及并发症总发生率显著低于对照组(P＜0.05,P＜0.01),单通道1 h液体补充量显著多于对照组(P＜0.01).结论 应用颈外静脉留置针通道能有效提高上消化道大出血患者静脉输液护理质量,有利于患者的救治.     

中心静脉导管在胸腔积液引流中的应用及护理

对37例胸腔积液的患者采用中心静脉导管穿刺引流并注入化疗药物。结果一次穿刺成功100%,5例置管过程中发生堵管,冲洗后畅通,置管6～24(17.5±5.5)d。提出中心静脉导管减轻了患者反复穿刺引流胸水的痛苦,须加强置管后的皮肤和导管护理。     

经外周静脉穿刺中心静脉置管的护理

目的观察经外周静脉穿刺中心静脉导管(PICC)在护理中的应用效果。方法选取我院外科病房2012年2月至2014年4月采用PICC置管的造口疝、切口疝及晚期肿瘤患者共56例,进行观察总结。结果 56例PICC置管患者未见并发症。加强PICC置管的护理观察及存在临床的护理问题,常见并发症处理及护理对策。为临床护理实践工作提供非常有效的护理指导。结论 PICC置管的临床应用,大大提高了护理工作效率,为长期输液患者减轻痛苦。     

颈外静脉穿刺置管在大量输液中的应用

目的探讨颈外静脉穿刺置管用于大量输液患者的效果，以寻找最佳输液途径。方法将需大量输液（每日补液量≥2500m1）的100例患者随机分为观察组和对照组各50例，观察组采用颈外静脉留置针输液，对照组采用四肢浅静脉留置针输液。结果两组患者一次置管成功率比较，差异无显著性意义（P〉0．05）；两组平均留置时间，导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较，差异有显著性意义（P〈0．05，P〈0．01）。结论颈外静脉穿刺置管用于大量输液，可减少静脉置管并发症，且可延长留置时间。     

颈外静脉穿刺置管在大量输液中的应用

目的 探讨颈外静脉穿刺置管用于大量输液患者的效果,以寻找最佳输液途径.方法 将需大量输液(每日补液量≥2 500 ml)的100例患者随机分为观察组和对照组各50例,观察组采用颈外静脉留置针输液,对照组采用四肢浅静脉留置针输液.结果 两组患者一次置管成功率比较,差异无显著性意义(P＞0.05);两组平均留置时间,导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较,差异有显著性意义(P＜0.05,P＜0.01).结论 颈外静脉穿刺置管用于大量输液,可减少静脉置管并发症,且可延长留置时间.     

中心静脉置管术360例体会

作者单位:317300仙居,浙江省仙居县中医院当前中心静脉置管术已在各医院广泛应用,以满足临床上静脉营养、长时间输液、化疗以及中心静脉压监测等需要。本院自1996年6月至2002年12月,共施行中心静脉置管360例,现将应用体会报告如下。1临床资料本组共360例,男252例,女108例。经颈内静脉穿刺置管315例,其中低位法106例,中位法209例;经颈外静脉穿刺置管8例;经股静脉穿刺置管37例。不同途径的置管并发症及遇到的问题见表1、表2。导管放置时间最长93天,最短为2.5天,中位9.3天。导管非主动拔出者均以脱管计数。2讨论2.1中心静脉置管途径选择。中心…     

Internal Jugular Vein Occlusion Test for Rapid Diagnosis of Misplaced Subclavian Vein Catheter into the Internal Jugular Vein

Background : During subclavian vein catheterization, the most common misplacement of the catheter is cephalad, into the ipsilateral internal jugular vein (IJV). This can be detected by chest radiography. However, after any repositioning of the catheter, subsequent chest radiography is required. In an effort to simplify the detection of a misplaced subclavian vein catheter, the authors assessed a previously published detection method.

Methods : One hundred adult patients scheduled for subclavian vein cannulation were included in this study. After placement of subclavian vein catheter, chest radiography was performed. While the x-ray film was being processed, the authors performed an IJV occlusion test by applying external pressure on the IJV for approximately 10 s in the supraclavicular area and observed the change in central venous pressure and its waveform pattern. The observations thus obtained were compared with the position of catheter in chest radiographs, and the sensitivity and specificity of this method were evaluated using a 2 x 2 table.

Results : In 96 patients, subclavian vein cannulation was successfully performed. In four patients, cannulation was unsuccessful; therefore, these patients were excluded from the study. There were six misplacements of venous catheters as detected by radiography. In five (5.2%) patients, the catheter tip was located in the ipsilateral IJV, and in one (1.02%), the catheter tip was located in the contralateral subclavian vein. In the patients who had a misplaced catheter into the IJV, IJV occlusion test results were positive, with an increase of 3-5 mmHg in central venous pressure, whereas the test results were negative in patients who had normally placed catheters or misplacement of a catheter other than in the IJV. There were no false-positive or false-negative test results.     

Aneurysm of the Splenic Vein

Aneurysms of the portal venous system are increasingly reported in the past five years. Congenital weakness of the venous wall, trauma, pancreatitis and portal hypertension are possible etiologies. Surgical intervention is indicated in case of symptomatic aneurysms with or without progressive expansion of the aneurysm diameter. The treatment of asymptomatic splenic vein aneurysms remains debated. We report the case of an asymptomatic and uncomplicated splenic vein aneurysm for which a conservative approach was advocated with regular follow-up by means of Doppler ultrasonography. After six years of follow-up the aneurysm diameter has not changed and no complications were observed.     

回压静脉法在静脉穿刺困难患者中的应用

目的提高静脉血管充盈不佳患者的穿刺成功率,减轻患者痛苦。方法采用自身对照法,对112例静脉穿刺困难患者按输液单双日采用不同方法进行静脉穿刺。双日采用传统方法如握拳、拍打局部使静脉充盈后进行静脉穿刺（传统法）;单日采用从静脉远心端向近心端推压3～6次后行静脉穿刺（回压法）。比较两种方法浅静脉充盈程度及一次穿刺成功率。结果回压法浅静脉充盈良好率显著高于传统法（P〈0.01）,一次穿刺成功率回压法与传统法比较,差异有显著性意义（P〈0.05）。结论回压静脉穿刺方法可提高静脉穿刺成功率。     

Long-term Results of Vein Sparing Varicose Vein Surgery

The aim of this study was to assess the long-term functional outcome of vein sparing varicose vein surgery using handheld Doppler ultrasound (HHD). The series consisted of 171 consecutive day-case surgery patients operated on for uncomplicated lower limb varicose veins. Venous segments considered competent were spared based on clinical examination and HHD, which was performed preoperatively only when deemed necessary by the surgeon. After a mean follow-up of 8 years all patients were examined, a systematic HHD evaluation was performed, and the findings were classified according to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification, and disability scoring was performed. During the follow-up period 17% of the legs were reoperated or scheduled for reoperation. At follow-up 79% of all patients were asymptomatic without reoperation. In 24%, recurrent varicosities were present and venous reflux was demonstrated by HHD. Recurrence was two times more common when the saphenofemoral junction had originally been left intact. Of all recurrent cases, reflux was demonstrated in the long saphenous vein (LSV) above the knee in 62%, in the LSV below the knee in 7%, in the short saphenous vein (SSV) in 16%, in the posterior arch vein in 38%, and in a thigh perforator in 8%. Of the legs reoperated during the follow-up period 41% presented with venous reflux at the follow-up visit. We conclude that HHD efficiently reveals sites of reflux that have been missed during previous surgery and that a thorough preoperative HHD examination and marking of reflux routes is required.     

Great Mediastinal Vein Reconstruction Using Autologous Superficial Femoral Vein Superficial Femoral Vein Graft

Abstract Background and Aim: Great mediastinal veins may be reconstructed using autologous, synthetic, or allograft conduits. Autologous conduits have been found superior to other conduit options. The superficial femoral vein (SFV) offers excellent early patency, minimal lower limb morbidity, and ease of harvest without accessory suture lines. Although rarely used, the SFV provides an acceptable alternative for conduit in large vein reconstructions. Methods: Two recent cases using SFV for great mediastinal vein reconstruction were reviewed and operative technique of vein harvest detailed. Results: This is the first report of successful reconstruction of a left superior vena cava using SFV conduit. Both superior vena cava (SVC) reconstructions reported were perfectly patent at intermediate term follow‐up (20 and 14 months) as determined by computed tomography angiogram or magnetic resonance imaging. Conclusions: Successful and durable reconstruction of the SVC or a persistent left subclavian vein is possible with minimal morbidity using the SFV.