一种新的颈内静脉穿刺置管方法

临床常需颈内静脉穿刺置管 ,进行补液、心脏起搏及中心静脉压测定等 ,但其传统的操作方法创伤性损害较大且失败率较高。笔者在尸体颈部解剖的基础上 ,对颈内静脉穿刺方法作了创新改进 ,效果满意 ,报告如下。方法　患者取平卧位 ,保持颈部近中位 (左转4 5°) ,并予颈部放松 ,择胸锁乳突肌内二头肌构成的角平分线与环状软骨水平线之交点 ,作为穿刺点 (图1)。消毒、铺巾、用 7号细针局麻、沿上述角平分线方向 ,保持针与皮肤冠状夹角 30°。负压状态进针 ,抽得静脉血示穿刺成功 ,保留穿刺细针位置不变脱开注射器。在细针毗邻处破皮 ,即可在细针…     

超声引导下经颈内静脉穿刺置入中心静脉导管的应用

目的 探讨超声引导下经颈内静脉穿刺置入中心静脉导管的临床应用价值.方法 2010年1月-2011年6月,对140例需要实施中心静脉置管的手术病人随机均分为超声组(采用超声引导经颈内静脉穿刺)和对照组(采用传统体表解剖标志经颈内静脉穿刺),对两种方法 进行对照研究,记录从消毒铺巾至成功置入中心静脉导管需要的穿刺时间、穿刺次数、成功率及有无并发症.结果 超声组70例患者在超声引导下行中心静脉置管首次穿刺成功65例(92.9%),总成功率为100.0%,对照组一次穿刺成功44例(62.8%),总成功率为91.4%,两组首次穿刺成功率和总成功率差异有统计学意义(P<0.05或P<0.01).超声组的平均穿刺时间为(4.2±1.3)min,明显短于对照组的(7.9±2.1)min,差异有统计学意义(P<0.01).超声组无并发症发生,对照组为6例(8.6%),两组并发症发生率差异有统计学意义(P<0.05).结论 超声引导法首次穿刺成功率明显优于传统标记法,且穿刺时间明显缩短,并可避免并发症的发生,可见超声引导下经颈内静脉穿刺行中心静脉置管具有安全、有效和不良反应少等优点.     

围术期颈内静脉穿刺置管术并发症的预防

围术期行颈内静脉穿刺置管可建立有效静脉通路，利于输注药物和实施胃肠外营养，并可监测中心静脉压等血流动力学指标。但若操作不当，也会引起相应并发症，甚至危及患者生命。如何正确应用并尽可能预防并发症的发生至关重要。本文结合作者围术期行颈内静脉穿刺置管术的临床实践，对其临床并发症的预防进行探讨。     

简便低位颈内静脉穿刺置管110例报告

颈内静脉穿刺置管多需要专用深静脉穿刺包，其费用较高。为降低患者负担，简化操作，我们改用低位法颈内静脉穿刺留置套管，经临床100例患者（要幼儿45例）使用，效果良好。现介绍如下。     

超声引导下右颈内静脉穿刺置管在血液透析中的应用

目的总结右颈内静脉穿刺置管的经验,探讨超声引导下右颈内静脉穿刺置管在血液透析中的应用价值。方法回顾性分析535例使用传统盲穿、超声定位及超声引导三种方法行右颈内静脉穿刺置管术成功率、穿刺时间、病人满意度和发生并发症的种类和例数。结果传统盲穿218例中,一次成功103例（47.25%）,穿刺时间（65±11）s,总成功率83.01%（181例）,发生局部气肿、血肿17例（7.80%）,误伤颈动脉9例（4.29%）,神经损伤3例（1.38%）,血气胸1例（0.46%）,病人满意度54.13%;超声定位210例中,一次成功121例（57.62%）,穿刺时间（45±8）s,总成功率91.43%（192例）,发生局部气肿、血肿12例（5.71%）,误伤颈动脉4例（1.90%）,神经损伤1例（0.48%）,无血胸、气胸病例,病人满意度77.62%;超声引导107例,一次成功92例（85.98%）,穿刺时间（30±7）s,总成功率100%,除1例发生局部皮下血肿外,未发生其他并发症,病人满意度达82.22%。与传统盲穿比较,超声定位,尤其超声引导穿刺有很大的优越性。结论血液透析患者行右颈内静脉穿刺置管,是一种风险较大的有创性操作,在超声引导下穿刺能缩短操作时间,提高成功率,减少并发症,提高病人满意度。     

静脉穿刺置管术在儿科中的应用

目的静脉输液是儿科护理工作的重点、难点,患儿见针就哭,挣扎抗拒、大汗淋漓的现象在病房司空见惯。为了减少患儿痛苦,保护血管,方便临床用药和紧急抢救,减轻护理工作量。方法分析对168例患儿进行头皮静脉穿刺置管术的输液方法及效果。结果 168例患儿静脉穿刺置管术,留置时间2～8d,平均6d。无1例因应用留置针而出现全身感染。结论静脉穿刺置管术是值得在临床推广应用的一种很好的输液方法 。     

18例高位颈内静脉置管临床应用

中心静脉穿刺置管有多条途径,但唯有颈内静脉标志相对明显操作简单方便,而且血胸、气胸等并发症较锁骨下静脉穿刺少.故是目前在农三师医院采用最多的中心静脉置管途径.农三师医院地处较偏远的基层单位,2007年1月份以来,通过对18例病人应用高位颈内静脉穿刺置管法,发现其具有快速安全、有效的特点.     

床边超声引导下颈内静脉置管78例临床分析

颈内静脉置管在临床应用广泛,特别是在危重症患者的紧急抢救中发挥着重要作用.传统的颈内静脉置管操作方法置管失败率高,置管并发症多.研究显示超声引导下深静脉穿刺可以明显降低并发症,缩短深静脉穿刺操作时间,提高成功率[1].本文通过对床边超声引导下颈内静脉置管和常规的置管方法进行对比分析,评价超声引导下行颈内静脉穿刺置管的临床应用价值.     

颈内静脉置管技术在血液透析中的应用

近年来，我院采用颈内静脉置管技术为40例临床急诊透析和诱导透析患者建立临时性血管通路，效果满意，现报告如下。     

心理疏导在经外周静脉穿刺中心静脉置管肺癌患者中的临床应用

<正>经外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)是从外周静脉进行穿刺,导入导管,将导管末端留置于上腔静脉或锁骨下静脉处,主要用于输入营养液,化疗药物等,为患者提供一条无痛性输液通道~([1])。在癌症治疗过程中,特别是在放化疗治疗过程中,患者常伴随产生焦虑、抑郁、敏感、丧失信心等负性情绪~([2])。加之PICC导管的长期留置可能引起并发症,如导管阻塞、静脉炎、感     

Traumatic internal jugular vein cannulation

A 63-year-old man with acute myocardial infarction complicated by atrioventricular block underwent an insertion of a temporary electrode for cardiac pacing. The posterior approach for right internal jugular vein cannulation was used. A 15-gauge needle was inserted under the sternocleidomastoid muscle aiming at the suprasternal notch with a 30-degree posterior angle of entry. An hour later the patient started to hiccup. The hiccups were resistant to drug therapy and to cessation of pacing. A chest radiograph revealed elevation of the right diaphragm and hematoma on the right side of the trachea, possibly compressing the right phrenic nerve on its route beneath the sternocleidomastoid muscle and the internal jugular vein. Within seven days the hiccups gradually ceased. Our case shows the advantages and complications of internal jugular vein cannulation.     

高危患者颈内静脉穿刺术的经验与教训

目的:总结高危患者颈内颈脉穿刺术的经验。方法:回顾性分析4例慢性肾功能衰竭患者颈内静脉穿刺术的方法及出现渗血、血肿的原因。结果:穿刺过程中1例误入动脉,3例顺利穿刺入颈内静脉。分别于穿刺后4h内,不同时间穿刺侧颈部出现血肿,被迫施行气管插管和切开术。结论:肾功能衰竭患者出凝血机制异常,用肝素后更易发生出血。一旦发生出血,应积极采取有力措施。     

经皮颈内静脉长期导管在老年维持性血液透析患者中的临床应用

目的：探讨经皮颈内静脉长期导管在老年维持性血液透析患者中的应用及其常见并发症的防治。方法对2009年12月至2012年12月在中南大学湘雅医院行经皮颈内静脉长期置管的15例维持性血液透析老年患者的临床资料进行回顾性分析,观察置管术后情况、导管的使用情况、常见并发症的防治、透析充分性评价等。结果（1）实施颈内静脉长期置管18例次,其中3例为重新置管,置管成功率100%。（2）导管相关并发症：2例患者术后1周内出现置管处局部渗血;1例出现导管出口感染,2例发生导管相关性血流感染;3例患者出现导管血栓形成;2例诊断导管纤维鞘形成;1例因人为损坏出现导管破裂。经过相应处理后均使问题得到解决。（3）导管使用期限：本组患者长期导管使用时间为4～41个月,除1例死亡（原因为脑出血）,3例为重新置管,余患者仍继续使用。（4）透析充分性评价：15例患者平均尿素下降率为72%,平均尿素清除指数达1.54。结论对于血管条件差无法建立动静脉内瘘的老年血透患者,使用颈内静脉长期导管行血液透析可以达到充分透析;提高置管及导管护理技术、加强健康宣教,能延长导管使用年限,减少导管并发症。     

Correlation of internal jugular and subclavian vein diameter variation on bedside ultrasound with invasive right heart catheterization

IntroductionAccurate estimation of fluid status is paramount in patients with heart failure. We hypothesized that bedside ultrasound assessment of the internal jugular vein (IJV) and subclavian vein (SCV) could reliably estimate right atrial pressure (RAP).MethodsProspectively enrolled patients were positioned supine. IJV was imaged at the apex of the right sternocleidomastoid muscle and SCV was imaged at the lateral third of the right clavicle. Using M-mode on a portable ultrasound machine, the maximum (D_max) and minimum (D_min) anteroposterior diameters were noted during normal breathing. Respiratory variation in diameter (RVD) was calculated as [(D_max – D_min)/D_max] and expressed as percent. Collapsibility was assessed with sniff maneuver. Patients then underwent right heart catheterization and their findings were correlated with above.ResultsTotal of 72 patients were enrolled with mean age 61 years, mean BSA 1.9 m², and left ventricular ejection fraction 45 ± 20%. Elevated RAP≥ 10 mmHg was associated with dilated IJV D_max(1.0 vs. 0.7cm, p = 0.001), less RVD with resting respiration (14% vs. 40% for IJV, p = 0.001 and 24% vs. 45% for SCV, p = 0.001), and reduced likelihood of total collapsibility with sniff (16% vs. 66% patients for IJV, p = 0.001 and 25% vs. 57% patients for SCV, p = 0.01). For RAP ≥10 mmHg, lack of IJV complete collapsibility with sniff had a sensitivity of 84% while IJV D_max > 1cm and RVD <50% had a specificity of 80%.ConclusionThe IJV and SCV diameters and their respiratory variation are reliable in estimating RA pressure.     

Incompetence of the internal jugular venous valve: spectrum of echo-Doppler appearances

The echocardiographic literature contains very scant reference to incompetence of the valve in the internal jugular vein. However, we found frequent Doppler evidence of such incompetence, especially in patients with congestive failure. This incompetence manifests as a variety of color Doppler and pulsed Doppler patterns, illustrated here in 3 patients.     

Angiotomographically-proven left innominate vein occlusion in dialysis patients with prior left internal jugular vein catheterization presenting with arm swelling after ipsilateral access creation: report of four cases

Central vein occlusion (CVO) is not uncommonly observed after hemodialysis (HD) catheter placement and it may prevent subsequent ipsilateral arteriovenous (AV) access creation. Right internal jugular vein catheterization (RJVC) appears to be the insertion site with the lowest incidence of CVO, but little is known about the incidence of CVO following left internal jugular vein catheterization (LJVC). We report on four patients with left innominate vein occlusion after LJVC who developed severe arm swelling after ipsilateral AV access creation. In three of the four cases swelling appeared 12-26 months after access creation, and in the fourth, swelling developed immediately after surgery while the catheter was still in place. Two patients underwent access ligation and in the remainder the arm swelling improved either spontaneously or after LJVC removal. LJVC is not as safe as RJVC as an insertion route for HD catheter placement in terms of CVO frequency.     

Intravenous pyogenic granuloma in the internal jugular vein: A case report and literature review

Rationale:Intravenous pyogenic granuloma (IVPG) is a special type of pyogenic granuloma, and its preoperative diagnosis is difficult. We report a rare case of IVPG that develops in the lumen of the internal jugular vein (IJV). Here, we analyze the imaging characteristics of present case and summarize the imaging characteristics of previous reported cases.Patient concerns:A 44-year-old man who presented with a growth in the IJV without any symptoms.Diagnoses:A diagnosis of IVPG was made, based on the pathological examination after surgery.Interventions:The patient underwent surgery to excise the vein segment containing the neoplasm.Outcomes:The patient did not present with any complications in the postoperative follow-up period.Lessons:For clinician, IVPG''s preoperative diagnosis is difficult. Although histopathology remains the gold standard for diagnosis, the combination of multiple types of imaging examinations is necessary to rule out the differential diagnoses of IVPG.     

超声对颅内静脉窦血栓患者颈内静脉介入治疗效果的评估

目的探讨应用彩色多普勒超声(CDU)检查颅内静脉窦血栓(CVST)患者颈内静脉(IJV)介入治疗的可行性和有效性。方法回顾性纳入12例经CDU诊断,MR静脉成像(MRV)和(或)DSA确诊的13支IJV病变(管腔局限狭窄9例,长段纤细2例,1例为右侧IJV局限性狭窄,左侧IJV长段纤细)并行IJV介入治疗(IJV支架置入5例和球囊扩张7例)的CVST患者。在IJV介入治疗前1周和治疗后1周、6个月、1年、2年应用CDU检查,比较IJV管径及最大血流速度(V_(max))的变化,分析介入治疗的成功率和远期疗效。结果治疗后1周CDU检查显示,13支IJV狭窄部位管径较术前明显增加(4.7±2.1)mm比[(2.3±1.3)mm,t=5.325,P0.01)]。IJV血流速度较术前得到改善[局限性狭窄10支(50±15)cm/s比(87±24)cm/s,t=6.285,P0.01]。对12例中6例(支架置入和球囊扩张各3例)患者进行了平均(18±7)个月的随访,2例球囊扩张术后患者发生了再狭窄。结论对于存在IJV病变的CVST患者,初步观察显示IJV介入治疗可以改善病变管腔及血流动力学,但介入治疗,尤其是球囊扩张术后再狭窄发生率较高。CDU可以作为IJV狭窄病变远期疗效的客观评估手段。