Femoral vein cannulation: a review

The femoral vein is an excellent potential venous access site. The technique of cannulation is described and its applications and complications are reviewed. More extensive future use of this technique is necessary to determine its proper role in emergency medicine.     

Central vein thrombosis: a complication of internal jugular vein cannulation.

Clinical signs of central vein thrombosis as a complication of internal jugular vein cannulation are rarely seen. Two infants who developed thrombosis of the superior vena cava and one adult who developed thrombosis of the left brachiocephalic vein are presented.     

Simulated internal jugular vein cannulation using a needle-guiding device

Background

Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein.

Horner’s syndrome following internal jugular vein cannulation

We present two cases of Horner's syndrome occurring following uncomplicated internal jugular venous cannulation. An awareness of this potential complication will reduce confusion over the aetiology of anisocoria in critically ill patients. This consideration is important, since lesions in the central nervous system or carotid dissection following trauma might otherwise be suspected. Received: 25 July 1997 Accepted: 28 November 1997     

超声引导技术在新生儿颈内静脉穿刺置管中的应用

目的观察超声引导技术在新生儿(包括低体重儿)颈内静脉穿刺置管中的应用.方法 选取62例行胸腹部手术及体表大肿瘤切除术的新生儿(包括低体重儿),随机分成超声引导组(UG组)及体表标志定位组(S组),两组均先使用22G静脉留置针,穿刺置入外套管成功后,再行钢丝引导法置入双腔中心静脉导管.观察两组穿刺操作的成功率、更换穿刺点的次数、穿刺并发症及平均穿刺时间.结果 UG组的穿刺成功率为96.8%(30/31),明显高于S组的32.3%(10/31),差异有统计学意义(χ2=28.182,P=0.000);UG组的更换穿刺点的例数(2例)亦明显低于S组的例数(25例);穿刺并发症发生率为3.2%(1/31),亦低于S组的64.5%(20/31),差异有统计学意义(χ2=25.995,P=0.000);UG组平均穿刺时间为(4.366±1.137) min,S组平均穿刺时间为(13.70±5.34)min,两组比较差异有统计学意义(t=5.463,P=0.028).结论 超声引导新生儿颈内静脉穿刺是安全可行的技术,可极大提高穿刺成功率和减少穿刺并发症的发生.     

Improvement of internal jugular vein cannulation using an ultrasound-guided technique

Objective: To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU. Design: Prospective, randomized study. Setting: General Intensive Care Unit of a University Hospital. Patients: Seven-nine patients were assigned to internal jugular vein cannulation using anatomical landmarks alone (control group, n = 42) or with ultrasound guidance (ultrasound group, n = 37). Intervention: All cannulations were performed by junior house staff under the direct supervision of a senior physician. In the ultrasound group, an ultrasonography (7.5 MHz) was used and the transducer was covered by a sterile sheath. The placement and direction of the cannulating needle were determined on the ultrasound image. Measurements and results: Internal jugular vein cannulation was successful in 37/37 (100 %) patients in the ultrasound group and in 32/42 patients (76 %) in the control group (p < 0.01). Average access time was longer in the control group (235 ± 408 s vs 95 ± 174 s, p = 0.06) and carotid artery puncture occurred in five patients in each group (p = 0.83). Jugular cannulation was successful at the first attempt in 26 % in the control group and 43 % in the ultrasound group (p = 0.11). Thirty-two patients (86 %) in the ultrasound group and 23 patients (55 %) in the control group (p < 0.05) were cannulated within 3 min. The cannula could therefore not be inserted within 3 min in 19 patients (45 %) in the control group. Failure was explained by thrombosis (n = 1), small caliber of the internal jugular vein (< 5 mm, n = 3), abnormal vascular relations (n = 3). Among the ten primary failures of cannulation, an internal jugular vein catheter was able to be inserted in four cases by an experienced physician on the side initially selected and with ultrasound guidance in two cases. The catheter was inserted into the contralateral internal jugular vein under ultrasound guidance in the remaining four cases. Conclusion: Ultrasound guidance improved the success rate of jugular vein cannulation in ICU patients. Our results suggest that ultrasound guidance should be used when the internal jugular vein has not been successfully cannulated within 3 min by the external landmark-guided technique. Received: 4 November 1996 Accepted: 22 May 1997     

External jugular vein cannulation and its use for CVP monitoring

The techniques of external jugular vein (EJV) cannulation and central venous pressure (CVP) catheter placement using a J-tipped wire guide is described in detail. This technique has a high success rate with virtually no complications.     

Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation

Purpose

Ultrasound (US) is a useful tool for peripheral vein cannulation in patients with difficult venous access. However, few data about the survival of US-guided peripheral catheters in acute care setting exist. Some studies showed that the survival rate of standard-length catheters (SC) is poor especially in obese patients. The use of longer than normal catheters could provide a solution to low survival rate. The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique (LC) in acute hospitalized patients with difficult venous access.

Methods

This was a prospective, randomized controlled trial. A total of 100 consecutively admitted subjects in an urban High Dependency Unit were randomized to obtain US-guided intravenous access using either SC or LC after 3 failed blind attempts. Primary outcome was catheter failure rate.

Results

Success rate was 86% in the SC groups and 84% in the LC group (P = .77). Time requested to positioning venous access resulted to be shorter for SC as opposed to LC (9.5 vs 16.8 minutes, respectively; P = .001). Catheter failure was observed in 45% of patients in the SC group and in 14% of patients in the LC group (relative risk, 3.2; P < .001).

Conclusions

Both SC and LC US-guided cannulations have a high success rate in patients with difficult venous access. Notwithstanding a higher time to cannulation, LC US-guided procedure is associated with a lower risk of catheter failure compared with SC US-guided procedure.     

血透患者行颈内静脉置管术的护理体会

<正>开辟有效的血管通路是患者进行血液净化治疗必不可少的前提条件,稳定而可靠的血管通路是血液净化治疗正常进行的保证。护士对首次行颈内静脉置管术患者早期干预,使患者能够愉快地接受手术,及早地进行透析治疗,对延长患者生命起到了重要的作用,现将护理体会介绍如下。     

Needle and guidewire visualization in ultrasound-guided internal jugular vein cannulation

Study objective

Reimbursement for ultrasound-guided central lines requires documenting the needle entering the vessel lumen. We hypothesized that physicians often successfully perform ultrasound-guided internal jugular (IJ) cannulation without visualizing the needle in the lumen and that guidewire visualization occurs more frequently.

Methods

This prospective, observational study enrolled emergency physicians performing ultrasound-guided IJ cannulations over an 8-month period. Physicians reported sonographic visualization of the needle or guidewire and recorded DVD images for subsequent review. Outcome measures were the proportion of successful procedures in which the operator reported seeing the needle or guidewire in the vessel lumen and the proportion of successful, recorded procedures, in which a reviewer noted the same findings. Procedures were deemed successful when functioning central venous catheters were placed. Fisher exact test was used for comparisons.

Results

Of 41 attempted catheterizations, 35 (85.4%) were successful. Eighteen of these were recorded on DVD for review. The operator reported visualizing the needle within the vessel lumen in 23 (65.7%) of 35 successful cannulations (95% confidence interval [CI], 47.7%-80.3%). In 27 cases, the operator attempted to view the guidewire and reported doing so in 24 cases (88.9%; 95% CI, 69.7%-97.1%). On expert review, the needle was seen penetrating the vessel lumen in 1 (5.6%) of 18 cases (95% CI, 0.3%-29.4%). Among recorded procedures in which the operator also attempted wire visualization, the reviewer could identify the wire within the vessel lumen in 12 (75.0%) of 16 cases (95% CI, 47.4%-91.7%).

Conclusions

During successful ultrasound-guided IJ cannulation, physicians can visualize the guidewire more readily than the needle.     

Guide wire-sheath technique for pulmonary artery catheterization and central vein cannulation

The combination of a spring guide wire with a sheath introducer system has been successfully used for the routine placement of pulmonary artery and central venous catheters. The method, which is described is simple, quick, and safe. It is applicable to the initial placement of the catheter, to any necessary alterations in its position and to its eventual replacement with a central venous cannula.     

经外周中心静脉置管致静脉血栓形成的多因素分析

中心静脉置管在临床中的广泛应用，减轻了病人因反复穿刺及输注刺激性药物带来的痛苦，而由中心静脉置管引起的并发症却不能忽视，其中置管所致静脉血栓形成是最严重的并发症，甚至危及生命。据统计，约15％的中心静脉置管病人发生并发症，血栓形成位居第二（发生率约为2％～26％）。研究表明，股静脉置管血栓形成的并发症为21．5％，锁骨下静脉为1．9％，颈内静脉置管的血栓形成的危险约为锁骨下静脉的4倍。而经外周中心静脉置管（PICC）由于导管材质的改进，尚未见报道因PICC置管所致的静脉血栓形成。我科自2004年2月-2005年2月100例行PICC置管的肿瘤化疗病人中9例发生静脉血栓。现报道如下。     

实时超声引导成人颈内静脉穿刺置管的应用价值

目的探讨实时超声引导在成人颈内静脉穿刺置管中的辅助作用,以评价其临床价值。方法 180例需行颈内静脉穿刺置管的患者分为A、B两组(A组:按解剖部位行常规颈内静脉穿刺置管者100例;B组:实时超声引导下行颈内静脉穿刺置管者80例)。操作前简单评估穿刺难度及可能出现的并发症,分别记录准备时间、操作时间、穿刺次数、成功率及并发症等。结果 A、B组穿刺前评估颈内静脉穿刺置管困难者分别为15例和32例。A组89例置管成功(89%),B组80例均置管成功(100%),差异有统计学意义(P0.05)。B组穿刺困难者穿刺时间[(10.7±4.6)s]较A组明显缩短[(450.7±233.8)s],差异有统计学意义(P0.05)。A组穿刺困难者一次穿刺成功4例,穿刺总成功率为60%,B组穿刺困难者一次穿刺成功27例,穿刺总成功率为100%。A、B组发生误伤动脉、臂丛、血肿及气胸的几率分别为10.0%、2.0%、4.0%、1.0%和2.0%、1.0%、1.0%、0。结论实时超声引导可提高成人颈内静脉穿刺的成功率和安全性,尤其是穿刺置管困难的患者。     

经外周中心静脉置管致静脉血栓形成的多因素分析

中心静脉置管在临床中的广泛应用,减轻了病人因反复穿刺及输注刺激性药物带来的痛苦,而由中心静脉置管引起的并发症却不能忽视,其中置管所致静脉血栓形成是最严重的并发症,甚至危及生命。据统计,约15%的中心静脉置管病人发生并发症,血栓形成位居第二(发生率约为2%～26%)[1]。研