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。     

X线导引下锁骨下静脉穿刺置管术

目的　回顾性分析锁骨下静脉第 2段X线解剖特点 ,探讨X线导引下锁骨下静脉穿刺置管技术的要点。资料与方法　在X线实时监视下 ,采用Arrow中央静脉管 ,行锁骨下静脉穿刺上腔静脉置管 180例次 ,包括右侧 110例次 ,左侧 70例次。穿刺点取锁骨中点下 1～ 2cm ,采用改良Seldinger穿刺技术 ,穿刺针对准锁骨头方向斜向内上、紧贴锁骨后缘穿刺 ,Arrow导管头留置于上腔静脉 ,3M敷贴外固定导管。并记录导管进入锁骨下静脉第 2段的解剖位置。结果　锁骨下静脉第 2段一般走行于锁骨内侧中下 1/3处 ,占 80 .6 % (14 5 /180 )。其解剖位置在左右和性别之间无统计学差异 (P >0 .0 5 )。穿刺成功率 10 0 % ,对准锁骨头中下 1/3处 ,一针穿刺成功率达 95 %。无并发症发生。结论　X线导引下锁骨下静脉穿刺上腔静脉置管术安全、微创 ,成功率高。熟悉锁骨下静脉的X线解剖 ,掌握正确的穿刺方向 ,可以提高一针穿刺成功率。     

锁骨下静脉输液港的并发症及临床处理

目的：探讨锁骨下静脉输液港的并发症,分析临床处理方法及疗效。方法：回顾性分析150例行锁骨下静脉输液港置入术的患者病例资料,记录并发症的发生及临床处理方法及疗效。结果：147例患者完成锁骨下静脉输液港系统置入术,操作成功率为98%;操作时间为25-60 min,平均43 min;3例手术失败,其中1例气胸,2例穿刺锁骨下动脉;近期并发症的发生率为6.67%;远期并发症发生率为14%。结论：锁骨下静脉输液港置入术操作简单、使用安全,临床操作及护理程序的提高有利于减少并发症的发生。     

超声引导特殊体位下颈内静脉穿刺置管56例临床效果分析

目的探讨超声定位对特殊体位下颈内静脉穿刺置管的临床价值。方法对特殊体位下超声定位颈内静脉穿刺置管56例进行回顾性分析。结果本组56例经颈内静脉成功置管55例,其中半卧位穿刺置管52例,端坐位穿刺置管4例,成功率98.21%,失败1例改行超声定位经同侧锁骨下静脉穿刺置管成功,全程操作时间7-15min,平均10min;其中并发局部血肿1例,无气胸、神经损伤、空气栓塞发生。结论超声定位下特殊体位颈内静脉穿刺置管高效、准确、安全,可作为提高一次性穿刺成功率及降低特殊体位深静脉穿刺置管风险的有效措施,具有较好的临床实用价值。     

右锁骨下静脉药盒导管系统置入术的临床应用

目的 探讨右锁骨下静脉药盒导管置入术的并发症,评价其临床价值. 资料与方法 85例患者在透视下行右锁骨下静脉药盒导管系统置入术,记录并发症的发生及临床应用情况. 结果 83例患者成功完成右锁骨下静脉药盒导管系统置入术,手术成功率为97.65%(83/85);操作时间为30～60 min,平均45 min;2例手术失败,其中1例气胸,1例穿刺锁骨下动脉;3例(3.52%)出现感染;2例(2.35%)化疗药外溢致局部皮肤坏死;5例 (5.88%)导管堵塞;皮肤切口延迟愈合4例(4.70%).使用该装置的患者感觉在输液治疗中的舒适程度高于其他静脉输注方式. 结论 右锁骨下静脉药盒导管置入术安全、便捷、并发症少,能够提高需要长期输液治疗患者的生活质量.     

不同定位方法锁骨下静脉穿刺的临床观察

中心静脉穿刺置管是一项基本的临床操作技术,用于危重患者的抢救和大手术输血输液、血流动力学监测,以及“化疗”、静脉高营养、安装临时心脏起搏器和长期输液静脉穿刺困难的患者。其中,经锁骨下静脉穿刺,具有操作方便、导管容易固定、护理便利等优点。我们自2003-05~2006-10采用两种不同的定位方法行锁骨下静脉穿刺,临床观察其穿刺的成功率和安全性。现报告如下。1资料与方法1.1临床资料:选择需中心静脉穿刺置管患者358例,男215例,女143例,年龄16~75岁,平均(42.0±10.8)岁,手术306例、非手术52例,其中经左锁骨下静脉穿刺者4例(3例右侧穿刺…     

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。     

经大隐静脉穿刺置管溶栓治疗急性期髂股静脉血栓形成

目的:探讨经大隐静脉入路置管溶栓治疗髂股静脉血栓形成的应用价值。方法:对18例急性期髂股静脉血栓形成的患者在下腔静脉滤器植入术前提下,经大隐静脉入路置管溶栓治疗。结果:18例患者经大隐静脉穿刺成功置管,技术成功率为100%,治疗有效率为100%。置管期间无不良反应及并发症发生;平均住院时间为12.5d。结论:经大隐静脉入路置管溶栓介入治疗急性期髂股静脉血栓操作简便,经济实用,安全有效。     

介入法在难置型外周中心静脉置管中的应用分析

目的回顾分析介入法在难置型外周中心静脉置管(PICC)中的应用价值及安全性。资料与方法 2008年1月至2010年11月经PICC专科护士会诊或操作后在床边直视下直接穿刺置入PICC管困难或失败的52例患者,在DSA下运用改良塞丁格技术置入三向瓣膜PICC管。对静脉显影不佳者采用顺行浅静脉造影穿刺靶静脉,对静脉迂曲或变异者采用微导丝导引法置管。结果 52例患者中50例成功置入PICC管,置管成功率96.1%。其中46例一次成功置管,4例第一次置入失败,第二次置入成功;全部病例均采用改良塞丁格穿刺技术,21例采用顺行浅静脉造影穿刺法,4例因头静脉注入深静脉角度过锐或腋静脉-锁骨下静脉段狭窄,走行迂曲而使用微导丝导引克服血管迂曲后置管成功,2例因双侧肘正中静脉缺如,头静脉及贵要静脉狭窄、闭塞置管失败。50例置管患者中,平均留管时间73天,2例(4.0%)发生深静脉血栓,其中1例(2.0%)发生致命性肺栓塞;1例(2.0%)发生无菌性静脉炎。结论 DSA导引下运用介入方法提高了PICC的置管成功率,减少了床边置管的盲目性。     

快速锁骨上两指定位法行锁骨下静脉穿刺置管在抢救失血性休克中的应用

目的:总结应用锁骨上两指定位法快速穿刺置管抢救失血性休克.方法:选准锁骨上缘量出两横指宽度,距锁骨上方1 cm处为穿刺点,边进针边回抽,见静脉血后左手固定穿刺针,右手通过穿刺针置入J型引导钢丝,置入中心静脉导管并固定.结果:应用此穿刺置管150例中,一针穿刺成功144例,成功率为98%,平均穿刺置管时间45 s,并成功进行迅速建立静脉通道补充血容量.结论:锁骨上快速两指定位法穿刺成功率高,迅速,为抢救病人赢得时间.     

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。     

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.     

Managing Inadvertent Arterial Catheterization During Central Venous Access Procedures

Purpose: Approximately 200,000 central venous catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication. Methods: Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous catheterization over a 5 year period. Results: It was not possible to obtain accurate figures on the numbers of central venous catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device. Conclusion: If inadvertent arterial catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device.     

Apheresis: another indication for radiologically placed central venous catheters.

OBJECTIVE: Apheresis is an important technique, used increasingly for a variety of conditions. It is sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study was to determine the safety and success of radiologic placement of CVCs for apheresis. METHODS: Data were collected prospectively for 278 CVCs placed under real-time sonographic or fluoroscopic guidance in the radiology department. Complications were noted in all cases; the number of passes required for venipuncture and whether this was achieved with a single wall puncture were noted in 265 cases; duration of catheterization and reason for removal of the catheter were recorded in all cases. The study group included 83 donors providing peripheral blood stem cells for allogeneic transplant. RESULTS: CVCs were successfully placed in all patients, 269 in the internal jugular and 9 in the femoral vein. In 87% of cases, only a single pass was required, and in 80% of cases venipuncture was achieved with a single anterior wall puncture. There was inadvertent but clinically insignificant arterial puncture in 6 cases (2%). In no case did this prevent CVC placement. Most catheters (211/274, 77%) were removed the same day. Only 3 catheters were removed prematurely (1%), 1 because of infection and 2 because of clotting. There was 1 case of venous bleeding. CONCLUSION: CVCs are safe for apheresis if real-time sonographic guidance is used for the puncture, guide wire and catheter placement are confirmed fluoroscopically, and the duration of catheterization is short.     

Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations

The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1–3), and 83% for adults and 90.3%, 1.25 (range, 1–5), and 49% for children, respectively. All the differences were statistically significant (p < 0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p > 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.     

经腘静脉顺行穿刺治疗下肢静脉血栓的探讨

目的：探讨经腘静脉顺行穿刺治疗下肢静脉血栓的可行性及优越性。方法：下肢静脉血栓患者19例，经对侧股静脉放置下腔静脉滤器后，使用骨科止血带加压成功穿刺腘静脉，15例顺行插管抽血栓，4例使用Amplatz血栓清除器（ATD）。结果：19例均获成功，栓塞血管复通达100％。临床症状消失，无症状性复发。结论：下肢静脉血栓中使用骨科止血带后可有效地提高顺行穿刺腘静脉成功率，是下肢静脉溶栓治疗的有效方法。     

顺行插管综合介入治疗下肢深静脉慢性血栓形成

目的 评价顺行性插管对下肢深静脉慢性血栓形成（LEDVT）的综合介入治疗的临床应用价值。方法 40例髂和（或）股静脉长段，全段或多节段血栓形成的患者。均经健侧股静脉穿刺先置入下腔静脉滤器，然后经患侧Guo静脉穿刺插管。综合运用血管内溶栓，血栓抽吸，血栓消融器消融。球囊成形术及腔内支架置入术治疗。结果 经皮Guo静脉穿刺插管成功率87.5%(35/40)。失败的5例改手术切开暴露Guo静脉再穿刺插管成功。综合介入治疗后总有效率100%。其中治愈率42.5%（17/40），显效率47.5%(19/40)，好转率10.0%(4/40)。无严重并发症发生。结论 经皮Guo静脉顺行性穿刺插管途径和结合多项介入技术综合运用治疗慢性LEDVT是安全有效的方法。     

Radiologic placement of tunneled central catheters: rates of success and of immediate complications in a large series.

OBJECTIVE: The objective was to examine the success and immediate complication rates in a large series of radiologically placed tunneled central venous catheters. SUBJECTS AND METHODS: We prospectively recorded the success and immediate complication rates in 880 consecutive radiologically placed tunneled central venous catheters. We also recorded the indication for placement, the success of placement, the number of passes required, and whether a double- or single-wall puncture occurred. RESULTS: Hemodialysis was the most common indication for long-term venous access. Venous access was successful in all patients, and catheter placement was successful in 99.4% of patients, with only five failed placements. All patients in whom placement was initially unsuccessful underwent successful placement the same day. All catheters were placed using real-time sonographic guidance. Most were placed in an internal jugular vein, with 87.4% requiring only a single needle pass. The immediate complication rate was only 4.0%, and no major complications occurred. CONCLUSION: To our knowledge, this series is the largest for which the immediate complication and success rates for radiologically placed central venous catheters have been reported. Our results suggest that radiologic placement of tunneled central venous catheters is a safe and effective alternative to surgery.     

不同途径中心静脉置管术前术后之共同处置事项临床分析

目的：不同途径中心静脉置管术术前术后的共同处置事项临床总结分析。方法：将68例需要中心静脉置管的患者按入院的时间先后随机分成两组,治疗组术前使用吗啡,术后用施乐扣固定并立即使用单次抗生素。对照组单纯按传统方法穿刺,术前术后不作以上处理。结果：治疗组患者并发症的发生率明显低于对照（P〈0.05）。结论：中心静脉置管术前注射吗啡术后使用施乐扣固定及使用单次抗生素能明显降低各种并发症的发生,舒适、安全。