永久性颈内静脉置管在血液透析患者中的应用

慢性肾衰竭是临床常见且多发疾病,晚期需要血液透析维持生命,有效的血管通路是患者血液透析的生命线,部分患者因年龄偏大,血管条件差等因素不能成功建立自体动-静脉内瘘,而人造血管内瘘价格昂贵,副作用较多。此时,永久性颈内静脉置管将成为较好的选择。我院从2002年1月以来,共行长期留置导管术18例,现报道如下。     

颈外静脉穿刺置管建立血液透析通道效果观察

对四肢静脉条件极差及无经济能力承受静脉置管的42例急诊血液透析病人行颈外静脉留置针（33例）或置管（9例）。结果均顺利建立血管通道，行血液透析313例次，效果满意。     

血液透析临时颈内静脉置管82例临床分析

<正>中心静脉置管因其操作简单、方便、危险性低而应用广泛,是目前建立血液净化系统临时血管通路的主要手段之一,已广泛应用于急性肾衰竭、慢性肾衰竭内瘘成熟前、各种类型中毒抢救等血液透析治疗。目前常用的深静脉置管部位包括颈内静脉、股静脉和锁骨下静脉,但是由于锁骨下静脉置管导致的静脉狭窄率高,影响该侧上肢内瘘的建立。因此,美国NKF-K/DOQI工作组建议如果患者需要做动     

颈内静脉置管与股静脉置管建立血液透析临时血管通路护理体会

建立和维护一个良好的血液循环系统通路 (血管通路 )是保证血液顺利进行和血液透析充分的重要条件。对于无法建立合适的动静脉瘘或经多次自体内瘘失败后无再建自体内瘘的理想部位 ,特别是因自体内瘘未成熟及急性肾衰竭、各类急性药物中毒、毒物中毒等而急需透析建立临时安全有效通路的病人 ,采用单针双腔导管插入颈内静脉或股静脉已成为血管通路的途径。现将我科 2 0 0 0年以来颈内静脉置管及股静脉置管在血液透析中对比观察结果及护理体会报告如下。资料与方法1　临床资料　共观察 2 0 0 0年 4月～ 2 0 0 3年 4月颈内静脉置管 4 5例 ,股静…     

特殊体位患者颈内静脉置管策略

目的探讨特殊体位患者行颈内静脉置管的可行性和临床效果。方法对47例特殊体位(被动体位9例,强迫体位38例)下行颈内静脉置管的患者作好物品与患者准备,根据不同体位确定穿刺步骤和固定导管。结果 47例颈内静脉置管均成功,其中一次置管成功38例。中心静脉置管留置4~151d,中位数22d。留置过程中无与置管相关的不良反应或并发症发生。结论对特殊体位患者行颈内静脉置管需重视各操作环节,尤其是穿刺点定位、穿刺方向、穿刺深度及角度,以提高置管成功率,减少置管相关并发症的发生。     

小剂量尿激酶在维持性血液透析右颈内静脉置管中的应用

建立有效的血管通路、保持血透通路的通畅是保证血透患者安全、有效进行血透的重要前提之一。右颈内静脉置管因其穿刺部位易暴露、血流量充足、操作方便、活动不受限制、与头臂静脉、上腔静脉几乎成一直线、插管容易成功等优点而被临床作为血管通路广泛应用于血透患者。     

血液透析患者右颈内静脉狭窄由颈外静脉置入卡夫导管1例报道

正1病例摘要患者,女,66岁,因"维持性血液透析4年余,右上臂内瘘闭塞1日"入院。患者4年前因为糖尿病肾病进展至终末期肾脏病行维持性血液透析治疗,病初因为患者外周血管条件欠佳而以右颈内静脉卡夫深静脉导管作为血管通路。透析1年后卡夫深静脉导管自行脱落出体外,再次行右颈部卡夫深静脉导     

大鼠颈外静脉置管方法的改进

目的为大鼠的肠外营养建立一条快速、长期和有效的输液方法。方法应用清洁级的Sprague-Dawley(SD)大鼠20只,戊巴比妥钠麻醉诱导,仰卧位固定于大鼠固定台,解剖手术区组织,暴露颈外静脉,玻璃分针挑起颈外静脉,阻断远端的静脉回流。将导管的楔形面垂直于操作台,进行血管穿刺,当有突破感时,垂直位改为平行于血管,将导管置入静脉,检查导管的通畅性,最后固定导管。结果 20只SD大鼠置管成功率为100%,术后3天导管脱落1只,术后7天(67%导管)血液回抽受阻,但注射生理盐水无阻力,术后15天(100%导管)血液回抽受阻,注射生理盐水无阻力。结论此种置管方法操作简单,能明显提高大鼠颈外静脉置管的成功率,并且缩短了置管时间。     

两种不同途径颈内静脉置管的比较

中心静脉置管术已逐步推广应用于大手术中输血、输液及术中监测中心静脉压(CVP)。本研究拟探讨新的途径行颈内静脉置管应用的可行性与特点,并与高位颈内静脉穿刺置管法进行比较。资料与方法一般资料拟施心脏手术病人60例,男38例,女22例,年龄8～60岁,按穿刺途径不同随机分为两组     

Prediction of a small internal jugular vein by external jugular vein diameter

The relationship between internal jugular vein diameter as measured with an ultrasound imaging machine (SiteRite, Dymax) and external jugular vein diameter was studied in 50 anaesthetised patients undergoing elective cardiac surgery. There was an inverse correlation between external jugular vein diameter and internal jugular vein diameter ( r  = −0.47, p < 0.001). All patients with an external jugular vein diameter of 7 mm or greater had an internal jugular vein diameter of less than 15 mm. No patient with an external jugular vein diameter of less than 7 mm had an internal jugular vein diameter of less than 20 mm. No other patient dimension (height, weight, body mass index, neck circumference) predicted internal jugular vein size. These results suggest that a large external jugular vein (i.e. 7 mm or greater in external diameter) may be associated with a small internal jugular vein. A size 5.0-mm internal diameter tracheal tube may be used to provide a rapid assessment of external jugular vein diameter.     

Catheterization of the external jugular vein for hemodialysis

Permanent central catheter for hemodialysis was inserted via external jugular vein in 95 patients. In all the cases the catheter blood flow was more than 250 ml/min. There were no severe complications. The procedure of insertion of permanent catheter for hemodialysis via the external jugular vein is described. It is concluded that the insertion of permanent catheter for hemodialysis via the external jugular vein is a simple and short-time procedure without any severe complications.     

经颈外静脉入路长期深静脉留置导管在维持性血液透析患者中的应用

目的回顾性分析经颈外静脉入路的长期带涤纶套深静脉置管在维持性血液透析患者中的应用．探讨其安全性和可行性。方法选择2003年6月至2008年6月在我院行颈外静脉入路的带涤纶套长期深静脉置管患者为观察组,共行置管术90例次;选择同期经颈内静脉入路长期深静脉置管患者为对照组,共行置管术304例次。比较2组导管使用寿命、透析充分性、退出原因及并发症发生情况。结果（1）2组导管平均生存时间分别为（34．2±3．9）个月、（32．6±2．3）个月,95％可信区间分别为（26．5441．8）个月、（28．1～37．2）个月,中位生存时间分别为31）、31个月,差异均无统计学意义（χ^2=1．060,P〉0．05）;（2）2组Kt／V分别为（1．49±0．36）、（1．50±0．41）,差异无统计学意义（P〉0．05）;（3）2组感染和血栓的发生率均无统计学差异（P〉0.05）。结论经颈外静脉人路长期深静脉置管是一种安全、有效的方法。     

Outcomes of tunneled femoral hemodialysis catheters: comparison with internal jugular vein catheters

BACKGROUND: Tunneled femoral vein dialysis catheters are used as a last resort when all other options for a permanent vascular access or thoracic central vein catheter have been exhausted. There is little published literature on the complications or outcomes of tunneled femoral catheters. METHODS: Using a prospective, computerized vascular access database, we identified all tunneled femoral dialysis catheters placed at the University of Alabama at Birmingham during a five-year period. The clinical features, catheter patency, and complications in these patients were compared to those observed in a group of sex-, age-, and date-matched control patients with tunneled internal jugular vein dialysis catheters. RESULTS: During the study period, 27 patients received a tunneled femoral dialysis catheter, accounting for 1.9% of all tunneled catheters placed. Only 7 patients (26%) were able to convert to a new permanent dialysis access. The primary catheter patency (time from placement to exchange) was substantially shorter for femoral catheters than for internal jugular dialysis catheters (median survival, 59 vs. >300 days, P < 0.0001). Infection-free survival was similar for both groups (P= 0.66). Seven patients with femoral catheters (or 26%) developed an ipsilateral deep vein thrombosis, but catheter use was possible with anticoagulation. CONCLUSION: Tunneled femoral dialysis catheters have a substantially shorter primary patency, but a similar risk of catheter-related bacteremia, as compared with internal jugular vein catheters. An ipsilateral lower extremity deep vein thrombosis occurs commonly after placement of a femoral dialysis catheter, but does not preclude continued catheter use.     

Central venous cannulation in infants and children: a comparison of internal and external jugular vein approaches

We prospectively evaluated success rate and complications associated with 436 internal (IJ) and external (EJ) jugular approaches to central venous cannulation in 377 paediatric patients. Variables studied included the route of insertion, success rate, cannulation time, intraoperative and postoperative catheter-related complications. The overall success rate and the frequency of complications were higher with the IJ than with the EJ approach. Cannulation with the EJ approach was more successful in older patients than in younger ones, making EJ a more attractive route for central venous cannulation in older children. While the inconsistent final position of the catheter tip makes EJ a less reliable technique for central venous pressure monitoring, it does not limit its usefulness for infusion of vasoactive drugs. If monitoring of filling pressures is desired, the IJ approach is a better choice, despite its higher risk of complications.     

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients

Objective To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P﹤0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age﹤65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.     

带毡套的颈内静脉血液透析导管留置致上腔静脉狭窄五例

带毡套的中心静脉导管长期留置容易出现多种并发症,如感染、导管血栓或纤维鞘形成、中心静脉狭窄等,导致导管功能不良,影响血液透析(血透)充分性.现报道带毡套的颈内静脉导管留置致上腔静脉狭窄5例及我们的诊治体会.     

Cerebral hemorrhage due to internal jugular vein stenosis in a hemodialysis patient

A 53 year old female with ESRD on hemodialysis presented with headache, vomiting, and lethargy that had started 2 h prior to presentation. Magnetic resonance imaging revealed parenchymal hemorrhage in the temporal, occipital, and cerebellar white matter. Magnetic resonance venography disclosed hypoplastic transverse sinus. On cerebral angiogram there was no evidence of cerebral aneurysm, vasculitis or vascular malformation. Angiogram demonstrated a high-grade stenosis was present in the left internal jugular vein (IJV) just below the anastomosis of the graft. There was retrograde high flow in the left IJV above the anastomosis of the graft, which fills a small left transverse venous sinus. There was also filling of the multiple abnormally enlarged leptomeningeal veins over the surface of the left cerebral and left cerebellar hemispheres. Retrograde blood flow was due to IJV stenosis which led to cerebral venous hypertension and intraparenchymal brain hemorrhage. She then underwent occlusion of her left brachiojugular dialysis graft. Thereafter, her mental status markedly improved and her headache resolved. Since IJV stenosis and hypoplastic transverse sinuses are not rare, patients with jugular grafts should probably be closely watched for symptoms of increased intracranial pressure. As awareness of vein preservation in CKD patients grows, the prevalence of CVS would probably decline in future.     

超声引导下经皮右颈内静脉穿刺置管术在血液透析中的应用

目的探讨超声引导下经皮右颈内静脉穿刺置管术在血液透析中的应用,分析超声引导穿刺的方法、注意事项及并发症预防。方法对297例慢性肾功能不全尿毒症患者进行超声引导下经皮右颈内静脉穿刺置管术,按照提高一次穿剌成功率的技术要点进行操作。结果本组患者均获得穿剌置管成功,其中244例1次穿刺成功（244/297,82.15%）,30例第2次穿刺成功（30/297,10.10%）,23例第3次穿刺成功（23/297,7.74%）。并发症发生率为15.15%（45/297）,31例因导管贴壁导致引血不畅流量不足。结论实时超声引导在右颈内静脉穿刺置管术中的应用,可极大提高穿剌的一次成功率,有效降低并发症的发生。