超声引导下经腋静脉置入中心静脉导管在心脏重症监护患者中的安全性和可行性：一项前瞻性观察研究中的新技术

2021-10-21 09:28

采用一种新的超声引导下支架辅助技术在腋静脉置入中心线导管可能是一种替代传统的颈静脉和锁骨下入路的可行、安全、快速的方法。

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超声引导下经腋静脉置入中心静脉导管在心脏重症监护患者中的安全性和可行性：一项前瞻性观察研究中的新技术

贵州医科大学麻醉与心脏电生理课题组

翻译：陈锐编辑：陈锐审校：曹莹

背景

中心静脉插管是心脏危重病人谨慎用液和用药的关键。腋静脉可能是锁骨下静脉和颈静脉入路的一种替代方法，其优点是在胸腔外，更远离胸膜间隙，给患者带来更多的舒适感。传统的超声引导腋静脉插管在技术上要求很高，而且不能保证针尖的精确可视化。

方法

我们描述了一种新的面内技术，用专用支架支撑针头，使针尖完全可控，并能连续显示针尖和血管，使操作更容易、更安全。在一项前瞻性观察研究中，我们还报道了在35例心脏重症监护患者中应用这种新方法的可行性和安全性，这些患者也接受了无创通气支持和/或充分抗凝。

结果

采用新技术，手术成功率97%，手术时间与其他置入部位相当，且无并发症。

结论

采用一种新的超声引导下支架辅助技术在腋静脉置入中心线导管可能是一种替代传统的颈静脉和锁骨下入路的可行、安全、快速的方法。

原始文献来源

Farina A, coppolaG, Bassanelli G, et al. Ultrasound-guided central ve-nous catheter placement through the axillary vein in cardiac critical care patients: safety and feasibility of a novel technique in a prospective observational study. Minerva anestesiol 2020;86:157-64. Doi: 10.23736/s0375-9393.19.13670-X)

Ultrasound-guided central venous catheter

placement through the axillary vein in cardiac

critical care patients: safety and feasibility of a novel

technique in a prospective observational study

原

文

Abstract

Background: Central venous catheterization is essential for careful administration of fluids and drugs in cardiac critical care patients. The axillary vein might represent an alternative to subclavian and jugular vein accesses, with the advantage of being extra-thoracic, more distal from the pleural space and with more likehood of comfort for the patient. Conventional ultrasound-guided cannulation of the axillary vein is technically demanding and does not guarantee precise visualization of the needle tip.

Methods: We describe a new in-plane technique with a dedicated bracket support for the needle, giving full tip control and continuous visualization of the tip and vessel, making the maneuver easier and safer. In a prospective observational study we also report the feasibility and safety of the novel procedure in a series of 35 cardiac critical care patients, also receiving non-invasive ventilatory support and/or being fully anti-coagulated.

Results: With the novel technique, we obtained 97% success with procedural times comparable to other insertion sites and without complications.

Conclusions: Placement of a central line catheter in the axillary vein using a novel ultrasound-guided bracket-assisted technique may be a feasible, safe and rapid alternative to the conventional jugular and subclavian approaches.

(Cite this article as: Farina a, coppola g, Bassanelli g, et al. Ultrasound-guided central venous catheter placement through the axillary vein in cardiac critical care patients: safety and feasibility of a novel technique in a prospective observational study. Minerva anestesiol 2020;86:157-64. Doi: 10.23736/s0375-9393.19.13670-X)

Key words: axillary vein; Ultrasonography; central venous catheters; cannula