超声引导改良婴幼儿颈内静脉穿刺置管术的临床研究

目的:探讨超声引导改良婴幼儿颈内静脉穿刺置管术的临床应用价值。材料和方法:随机抽取行先天性心脏病手术的婴幼儿60例分为2组(n=30)。A组:对照组,首选右颈内静脉中路,用20GY形穿刺针穿刺,再经Y型穿刺针置入J形引导钢丝,然后置入中心静脉导管。B组:实验组,在超声引导下用18GBD静脉外套管穿刺,经静脉外套管置入J形引导钢丝,然后置入中心静脉导管。记录两组穿刺置管总成功率、一次穿刺成功率、失败率及并发症。结果:B组总穿刺成功率高于A组(P<0.05),B组一次穿刺成功率显著高于A组(P<0.01),B组的穿刺并发症明显低于A组。结论:超声引导下经18G静脉留置针穿刺置管,大大提高了婴幼儿中心静脉置管的成功率,并降低了并发症的发生率,有很高的临床应用价值。     

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。     

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。     

脑损伤昏迷患者术后PICC与锁骨下静脉置管的疗效观察

目的：探讨PICC与锁骨下静脉置管在脑损伤昏迷患者术后置管输液治疗的疗效。方法回顾性分析79例行PICC及63例行锁骨下静脉置管输液治疗的脑损伤昏迷患者的临床资料,比较2种治疗方法的一次性置管成功率及导管置入相关并发症的发生率。结果 PICC一次穿刺成功率94.9％（75／79）,锁骨下静脉置管一次穿刺成功率为74.5％（47／63）,差异有统计学意义（P＜0.05）;PICC组发生机械性静脉炎、堵管高于锁骨下静脉组（P＜0.05）,而导管脱落、非计划性拔管的机率小于锁骨下静脉组（P＜0.05）,两组在导管位、导管相关性感染的发生率上差异无统计学意义（ P＞0.05）。结论 PICC与锁骨下静脉置管在脑损伤昏迷患者术后输流治疗中有简单易行、护理方便,留置时长等优点,相比较而言,PICC更具有优势。     

颈外静脉与颈内静脉穿刺置管的临床应用比较

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40例需行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。     

超声引导经腋静脉穿刺中心静脉置管的临床应用

目的 探讨应用超声引导经腋静脉穿刺中心静脉置管的安全性和有效性。资料与方法 回顾性选取2019年4月—2021年3月东莞光华医院实施中心静脉置管的180例患者,根据治疗方法分为锁骨下静脉穿刺组、超声引导下颈内静脉穿刺组和超声引导下腋静脉穿刺组,每组60例。超声检测锁骨下静脉穿刺组和超声引导下腋静脉穿刺组穿刺静脉深度、静脉直径、静脉与动脉间的距离、穿刺点与胸膜间的距离。记录3组患者一次穿刺成功率。比较3组患者感染、血栓、气胸、误穿动脉等并发症发生率。结果 超声引导下腋静脉穿刺组与锁骨下静脉穿刺组锁骨中线处静脉直径和深度差异无统计学意义(t=1.098,P=0.274;t=-1.886,P=0.064);超声引导下腋静脉穿刺组静脉与动脉的距离、与胸膜间的距离均大于锁骨下静脉穿刺组,差异有统计学意义(t=-11.993,P=0.000;t=-19.131,P=0.000);超声引导下颈内静脉穿刺组和超声引导下腋静脉穿刺组一次穿刺成功率均高于锁骨下静脉穿刺组,差异有统计学意义(χ²=6.988,P=0.008;χ²=5.175,P=0.024);超声...     

2种锁骨下静脉穿刺置管方法比较研究

目的 :探讨锁骨下静脉穿刺置管的方法 ,提高成功率 ,减少并发症的发生。方法 :110例患者采用传统方法操作 ,13 1例患者采用改进的方法操作 ,对两种方法效果进行比较。结果 :传统方法成功率92 .7%,改进的方法成功率为 98.4%(P <0 .0 5 ) ;传统方法操作时间平均为 3 4min ,改进方法为平均 2 3min ,传统方法并发症发生率为 6.3 %,改进方法为 2 .2 %。结论 :改进的锁骨下静脉穿刺置管方法安全有效 ,便于操作     

DSA引导下颈内、锁骨下及腋静脉入路输液港的临床应用

目的探讨DSA引导下颈内、锁骨下及腋静脉入路输液港的临床应用及安全性。方法 选取2016年3月28日至2018年6月28日在江阴市人民医院行DSA引导下静脉输液港植入术的肿瘤患者827例。根据患者输液港不同入路途径分为3组：经颈内静脉组（A组）125例,经锁骨下静脉组（B组）87例,经腋静脉组（C组）615例,比较3组患者的穿刺成功率及并发症发生情况。结果 DSA引导下A组首次穿刺成功率98.40%(123/125), B组穿刺成功率94.25%(82/87),C组穿刺成功率97.89%(602/615),差异有统计学意义（P<0.05）;其中B组穿刺成功率低于C组,其余各组间差异无统计学意义（P>0.05）。对所有患者随访（15.56±2.91）个月（3～26个月）,术后早期并发症总发生率为3.75%,A组为4.00%(5/125),B组为9.20%(8/87),C组为2.93%(18/615),其中B组发生率高于C组（P<0.016 7）,各类并发症组间比较差异无统计学意义（P>0.05）;术后远期并发症总发生率为4.72%(39/827), A组发生率为4...     

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…     

应用ARROW导管进行锁骨下静脉穿刺置管的评价

目的：评价应用ＡＲＲＯＷ导管进行锁骨下静脉穿刺置管的方法。方法：应用ＡＲＲＯＷ导管对６０例住院病人进行了锁骨下静脉穿刺置管。结果：穿刺置管成功率为１００％,在一针穿刺成功方面,右侧为８７．２３％,左侧为５７．１４％。结论：应用ＡＲＲＯＷ导管进行锁骨下静脉穿刺置管是一种安全、快捷的方法。     

Hemopericardium resulting from attempted internal jugular vein catheterization: A case report and review of complications of central venous catheterization

An unusual case of hemopericardium and presumed fatal cardiac tamponade complicating attempted right internal jugular vein catheterization by the posterior approach is reported. Reports of complications in a series of internal jugular vein catheterizations using various approaches (posterior, central, anterior, supraclavicular) and subclavian vein catheterizations are reviewed. Internal jugular vein catheterization is not necessarily safer than subclavian vein catheterization: numerous factors determine success rate and complication rate in central venous catheterizations.     

Effort-induced thrombosis: diagnosis with three-dimensional MR venography

A case of Paget-von Schr?tter syndrome diagnosed with gadolinium-enhanced magnetic resonance (MR) venography is described. MR enabled a comprehensive evaluation with identification of the thrombus within the left subclavian vein and a hypertrophied anterior scalene muscle as the probable cause of the patient's condition. We describe the MR venography technique used for evaluation of the subclavian vein and the imaging findings in this entity.     

Malpositions and complications following central venous catheterization in relation to the access site

Malpositions and complications following central venous catheterization largely depend on the site of venous approach. Malpositions are very common after subclavian vein catheterization, and even more common after left jugular vein catheterization. On the contrary, their incidence after right jugular puncture is very low. Among complications, pneumothorax is quite common after subclavian vein catheterization, and migration of the catheter towards the heart after right jugular puncture. Vascular damages may occur in any approach: their early detection on chest radiographs very much depends on a rigorous technique. Radiology plays an important role in the early detection of malpositions and complications, which is greatly facilitated by a few ml of contrast medium injected through the catheter.     

Internal mammary artery injury following subclavian vein catheterization

Inappropriate puncture of the internal mammary artery caused by subclavian vein puncture is a rare but potentially lethal complication. We report a case of 45-year-old woman with internal mammary artery injury following subclavian vein catheterization successfully treated by transcatheter arterial embolization using coils.     

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。     

Arterial abnormalities of the shoulder in athletes

Vascular lesions of the shoulder may be misinterpreted as one of the more familiar shoulder abnormalities by a treating physician. We are reporting on 13 athletes who were found to have symptoms related to compression of the subclavian or axillary artery or their tributaries. Nine were amateur or professional baseball pitchers. Severe arm fatigue or finger ischemia, secondary to embolization, were presenting symptoms. Arm fatigue was noted in all pitchers. After complete history and physical examination, including auscultation for bruits in functional positions, all athletes were evaluated by noninvasive tests (Doppler and Duplex scanning). Arteriography was performed with positional testing, recreating overhead activity, and complete radiographic visualization of the dye to the digital arteries. Two patients were found to have subclavian artery aneurysm. The remaining athletes were found to have compression of the subclavian artery beneath the anterior scalene muscle (five patients), the axillary artery beneath the pectoralis minor (two patients), both arterial segments (two patients), and one was found to have arterial compromise at the level of the humeral head. Branch artery compression was also noted. One pitcher occluded the posterior circumflex humeral artery with embolization to the digit. The two patients with subclavian aneurysms underwent saphenous vein bypass with cervical rib resection. All of the other athletes except one underwent resection of a 2 to 3 cm segment of the anterior scalene muscle or pectoralis minor muscles. All returned to their previous level of activity except one patient who developed impingement type symptoms and required acromioplasty. He is currently undergoing rehabilitation. Proper recognition of vascular compromise in the upper extremity of athletes is essential to avoid the catastropic complications of arterial thrombosis.     

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.