颈内静脉穿刺置管211例体会

我院自1990年11月至1995年5月以来施行颈内静脉穿刺置管211例,现报告如下: 1 器械与方法 1.1 穿刺针与留置导管 选择进口或国产静脉穿刺套管留置针。型号分别是1.7×133mm,1.6×100mm,1.6×170mm。 小心静脉留置管(西德贝朗公司BRAUN生产)套装内包括金属穿刺针,(φ1.3×70mm)弹簧金属导丝,(φ0.89×5mmm血管扩张器,输血饥输液测压留置管(φ1.1×2(×)mm)等。     

腋静脉穿刺的应用解剖学

在30具成年尸体上,观测了腋静脉的行程,分段,毗邻,并对经腋静脉插管至上腔静脉的长度和长度进行了测量。     

后入路颈内静脉穿刺置管386例分析

目的 探讨和总结后入路颈内静脉穿刺置管技术要点及术中注意事项.方法 我院自2011年1月至2012年1月接受后入路颈内静脉穿刺置管患者共386例,回顾性分析穿刺过程中及穿刺后并发症情况,总结穿刺技术要点.结果 术中并发症共15例(3.9％),其中误穿动脉5例(1.3％),穿刺置管失败5例(1.3％),血气胸2例(0.5％),心律失常1例(0.26％),术中出血2例(0.5％);术后并发症共13例(3.4％),其中导管感染5例(1.3％),导管周围渗液2例(0.5％),导管阻塞4例(1.0％),局部血肿2例(0.5％).结论 后入路颈内静脉穿刺置管术前定位非常重要,规范操作可以降低术中及术后并发症的发生率.     

腋静脉置管在大面积深度烧伤患者中的应用和护理

目的探讨腋静脉穿刺置管在重度烧伤患者中的运用及护理。方法对23例大面积深度烧伤患者选用腋静脉穿刺并留置导管,给予穿刺点皮肤的护理、导管的观察、拔管时的护理。结果 23例大面积深度烧伤患者留置导管时间5～7d,拔管后导管做细菌培养均为阴性。住院期间无一例因护理不到位导致感染及并发症,全部治愈出院。结论腋静脉穿刺置管并发症少,安全性高,留置导管期间加强导管的护理,严格执行无菌操作,可保证患者的安全,大大提高了重度烧伤患者治愈的成功率。     

肝移植术中心静脉穿刺置管的解剖定位研究

目的比较解剖定位颈内静脉和锁骨下静脉两种路径行中心静脉穿刺置管的成功率和并发症,为临床选择安全有效的穿刺路径提供参考。方法限期肝移植手术患者随机交叉研究,随机确定颈内静脉和锁骨下静脉穿刺的先后顺序。全身麻醉诱导后,由同一组麻醉医师依据解剖定位标志按确定的穿刺顺序完成颈内静脉穿刺置管、锁骨下静脉穿刺置管。记录成功置管前静脉穿刺次数、引导钢丝置入次数,置管时间;同时记录误入动脉、血肿形成、气胸等并发症的发生率。结果 42例限期肝移植手术患者入选该研究。颈内静脉和锁骨下静脉穿刺置管的次数分别为(2.3±0.7)次,(2.9±1.4)次(n=42,P0.05),置管时间分别是(1.58±0.49)min,(2.24±1.01)min(n=42,P0.05)。1例患者行颈内静脉穿刺时误入颈动脉,并发血肿;1例患者行锁骨下静脉穿刺后出现血肿。结论解剖定位穿刺颈内静脉比锁骨下静脉更容易更快捷。     

腋静脉留置技术在NICU的应用

腋静脉穿刺技术从1987年开始应用到临床以来[1],已经在很多领域得到应用。在NICU对危重新生儿早期常采用禁食,24 h不间断输液,特别是静脉营养(脂肪乳、氨基酸)溶液输注时,常因新生儿头皮及四肢血管管壁薄,管腔窄,留置过程中易导致静脉损伤,和静脉炎发生。采用PICC置管又会增加患者经济负担,而腋下静脉置管既可以有效延长置管时间,置管和导管维护方法容易掌握,是一条较为理想的输注营养液静脉通道。     

85例超声引导下颈内静脉穿刺置管临床体会

目的 探讨、评价超声引导下行颈内静脉穿刺置管的安全性和实用性,交流超声定位的方法与经验,提高定位的准确性.方法 超声探查颈内静脉,沿其走行做好体表标记,保持病人头、颈部位置绝对不动,沿体表标记线行血管穿刺术,用sedinger经皮穿刺法留置导管.结果 一次穿刺成功79例,成功率92.9%,二次穿刺成功4例,成功率4.7%,三次以上2例,占2.3%.结论 超声引导下行颈内静脉穿刺置管简便、安全,成功率高,可缩短穿刺时间,减少危重患者的体位不适及穿刺带来的风险,值得推广.     

50例锁骨下静脉置管困难处理及分析

肥胖和老年病人因其解剖因素,利用常规锁骨下进针法行锁骨下静脉穿刺置管,即使静脉穿刺成功,但置管困难时有发生.作者采用平移穿刺点和改变穿刺方向的方法,成功置管50例.报告如下.     

颈内静脉穿刺置管用于手术麻醉中输血输液的体会

我科从一九九0年开始至今七年时间开展颈内静脉穿刺置管技术,用于重大手术麻醉病人输液输血,重危病人术中抢救及晚期癌症病人术后治疗和高营养输入,收到较好效果,深受病人欢迎。过去采用锁骨下静脉穿刺用于重危病人输液,其操作难度大,并发症多。我科在本院率先开展颈内静脉穿刺置管技术,并逐渐在全院推广,现在这一技术普遍在重危病人、老年病人、晚期癌症病人等开展,在我科开展近百例穿刺过程     

Pediatric central venous catheterization

The aortic valve (AV) has been used as a surrogate marker for the superior vena cava‐right atrium (SVC‐RA) junction during the placement of central venous catheters. There is a paucity of evidence to determine whether this is a consistent finding in children. Eighty‐seven computed tomography scans of the thorax acquired at local children's hospitals from April 2010 to September 2011 were retrospectively collected. The distance between the SVC‐RA junction and the AV was measured by dual consensus. The cranio‐caudal level of the junction and the AV were referenced to the costal cartilages (CCs) and anterior intercostal spaces (ICSs). The results confirmed that the SVC‐RA junction has a variable relationship to the AV. The junction was on average 3.1 mm superior to the AV. This distance increased with age. In the <1‐year‐old age group, the junction was on average 1.3 mm superior to the AV (range: ?6 to 11 mm). In the 1–2 years old age group: 3.5 mm (range: ?8 to 15 mm). In the 3–6 years old: 3.8 mm (range: ?9 to 13 mm). In the >7 years old age group: 4 mm (range: ?11 to 16 mm). The surface anatomy of the SVC‐RA junction was variable, ranging from the second ICS to sixth CC. The SVC‐RA junction has a predictable relationship to the AV, and this can be used as an adjunct marker for accurate placement of central venous catheters except in the smallest neonates. Clin. Anat. 32:778–782, 2019. © 2019 Wiley Periodicals, Inc.     

Anatomical considerations of the anterior approach for central venous catheter placement

Central venous catheterization (CVC) entails the catheterization of the superior vena cava via either the subclavian or the internal jugular vein (IJV). This study looked at the frequency in which a needle was inserted into the IJV using the anterior CVC approach, which entails inserting the needle into the apex of Sedillot's triangle, formed by the sternal and clavicular heads of sternocleidomastoid (SCM). The ipsilateral distances from the apex of Sedillot's triangle to the superior aspect of the sternoclavicular joint and the diameter of the IJV were also measured. A needle was inserted into the apex of Sedillot's triangle in 36 adult cadavers with mean age of 62 +/- 19 years (mean +/- SD), mean height of 1.6 +/- 0.18 m, and a mean weight of 55 +/- 16 kg. Subsequent dissections of this area revealed the relation of the needle to the IJV. Results indicate that on the right, the needle was inserted into the IJV in 97.14% of the cases. On the left, the needle entered the IJV in 78.79% of the cases. From the sternoclavicular joint, the apex of Sedillot's triangle was found to be 40.87 +/- 1.62 mm and 38.73 +/- 6.34 mm on the right and left, respectively. The IJV diameter was 17.29 +/- 1.07 mm on the right and 15.30 +/- 0.25 mm on the left. We conclude that the anterior CVC approach is an anatomically accurate technique. It is furthermore important to realize that when performing any invasive procedure, a sound anatomical knowledge of the region is extremely important, as complications are often due to lack of understanding or misunderstanding of the relevant anatomy.     

Anatomic considerations in placement of central venous catheters

A knowledge of anatomy is essential for efficient and skillful placement of central venous catheters in seriously ill patients. The anatomy of the femoral, brachial, axillary, subclavian, external jugular, and internal jugular veins is described, and landmarks useful in achieving successful cannulation are discussed. Infectious and thrombotic complications of long-term cannulation are reviewed. Catheterization of the umbilical vein in the newborn infant is a very useful alternative approach to central venous cannulation in this age group.     

经皮穿股血管插管有关的应用解剖

在100具成尸标本上,观测了股动脉起点处各结构与髂前上棘至耻骨结节间径、髂前上棘至耻骨联合间径的位置关系。结果提示:经皮穿刺股动脉插管时,应以髂前上棘至耻骨联合间径中点进针为宜,行股神经阻滞麻醉时,应以髂前上棘至耻骨结节间径中点处进针为宜。     

急诊科深静脉穿刺置管术技能培训体会

深静脉穿刺置管术作为急诊科最常用的临床基本操作技能之一,常用于大量补液、中心静脉压力测定、化疗药物给药、肠外营养、临时心脏起搏以及血液净化治疗,尤其对急危重症的监测和治疗有着非常重要的意义[1]。我科结合实际情况,积极探索具有急诊科特色的深静脉穿刺置管术培训培训方法,     

A special anatomic preparation for teaching central venous catheterization

Catheterization of the subclavian and internal jugular veins is a commonly performed procedure for monitoring the hemodynamic, respiratory, and fluid status of patients as well as for delivery of special potent drugs and nutritive solutions. In inexperienced hands, this procedure can carry significant morbidity. A comprehensive central line placement teaching program has been developed at our institution centered upon an anatomy and catheterization skills workshop. A dedicated anatomic specimen has been prepared to emphasize key anatomical concepts about the subclavian and internal jugular veins. A design with easily reflectable flaps allows quick and simple visualization of needle position after supervised cannulation attempts. Workshop preparation and teaching sessions benefit from close collaboration between anatomists and clinicians. This should help standardize residents' exposure to central venous cannulation techniques and ensure basic procedure skills prior to actual cannulation in patients. © 1996 Wiley-Liss, Inc.