超声引导下动静脉穿刺置管

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,超声引导下动静脉穿刺置管,精细操作,精细解剖,精确定位,超声是重要的可视化技术,颈内静脉、锁骨下静脉、股静脉置管发生各种并发症的风险,麻醉相关心脏骤停,Newland,MC et al;Anesthestic-related Cardiac Arrest and Its Mortality:,A Report Covering 72,959 Anesthetics over 10 Years from a US Teaching Hospital,Anesthesiology:2002 971.108-115,日本 北海道 旭川医学院 铃木章浩 Anesth Analg 2021;107:347-348,While experienced operators using surface anatomic landmarks alone can,achieve a relatively high success rate with few complications,our department now requires all anesthesiologist to look with ultrasound before attempting central venous cannulation.,This seems especially important in children and other high risk situations such as patients with a coagulopathy.,Complications contributed to internal jugular vein cannulation,Crit Care.,2006;10(6):175.,平安性,Susan T.Verghese,M.D.,Willis A.McGill,M.D.,Ramesh I.Patel,M.D.,et,al Ultrasound-guided Internal Jugular Venous Cannulation in Infants Anesthesiology 1999;91 71-77,超声方法与体表标志法的比较,XIN CHUAN WEI MD,WEI WEI MD,YU LI MD A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children Pediatric Anesthesia 2005 Volume 15,Issue 9,733738,CA,IJV,超声引导下血管穿刺置管,MarieT.Aouad,MD,GhassanE.Kanazi,MD,FarajW.Abdallah,MD Femoral Vein Cannulation Performed by Residents:A Comparison Between Ultrasound-Guided andLandmarkTechnique in Infants and Children Under going Cardiac Surgery A&A 2021.,超声引导提高颈内静脉穿刺置管的成功率,A new Ultrasound-guided Arterial Cannulation Method in Sever Trauma Improve Success Rate,Hai-Bo Song,M.M,Xin-Chuan Wei,M.D.,Wei Wei,M.D.,Jin Liu,M.D.,Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China,Backgroud,Arterial cannulation may be very difficult and time-consuming in severe trauma patients with palpation method due to weak pulse.Complications were relate to multiple attempts to cannulate the artery.The purpose of this study was to establish a new artery cannulate method with ultrasound guided,avoiding traditional going through and draw pare ultrasound guided versus traditional palpation placement of arterial lines for time to placement,number of attempts,sites used.,Method,s,This was a prospective,randomized study at a tertiary university hospital.Inclusion criteria were severe trauma adult patients requiring arterial catheter insertion for intraoperative monitoring.Patients were randomized to 2 groups,group1 used ultrasound imaging to guiding arterial cannulation,group 2 used traditional palpation method.U-test,Wilcoxon signed rank sum test were used for statistical analysis.,Conclusions,In this study,a new ultrasound guidence method for artery cannulate was established,ultrasound image of radial artery and artery line was improved by a saline-filled balloon(figure 1,2).Compared with the palpation method,the success rate of ultrasound guidance for arterial cannulation was higher.Arterial line insertion took less time in ultrasound guidence group.Sever trauma patient could share benifit from ulrasound guidence artery cannulate.,Results,In our study,we establish a new ultrasound guidence method for artery cannulate by using a saline-filled balloon.The image quality of the radial artery and artery line was improved.26 adult patients were enrolled in our study,ultrasound-guided cannulate was success in all patients of Group 1 compared to only 10of 13(76.9%)patients in Group 2;all the patients of Group1 selected radial artery for cannulation,In Group2 radial,brachial or femoral artery were selected.Fewer attempts with the ultrasound guidengce were required than with the traditional technique(14vs 24,P 0.05).ultrasound group had a shorter time required for catheter insertion(57+/-86 secs vs.306+/-316secs,p=0.0006),超声引导已经成为中心静脉置管的标准方法;,超声引导可提高血管穿刺的平安性;,静脉穿刺前检查血管,可及时发现合并症.,超声引导标准的必要性,超声实时引导的指征建议,试穿次数3,试穿部位数1,试穿时间3min,试穿后颈部血肿,试穿后导丝、导管置入困难,体重10kg 或体重指数大于35,凝血功能异常,急诊抢救、危重症(缺氧、低血压、低血容量、肝肾衰竭),床旁教学,超声引导已成为标准方法,2002年9月英国临床技术研究院 将超声引导中心静脉置管作为标准方法在全国推广,超声引导纳入操作标准,Alan S.Graham,M.D.,et.al.N Engl J Med 2007;356:e21.,Andrea J.Parsons,MD Carotid Dissection:A Complication of Internal Jugular Vein Cannulation with the Use of Ultrasound Anesth Analg 2021;109,:135.,From the Department of Anesthesiology,University of Michigan,A morbidly obese 66-yr-oldman(Body MA Index56),缺乏训练-导致失败,手、眼不协调,内、外分不清,血管分不清,Harris N,Hodzovic I.Ultrasound for central venous cannulation,-are you trained to use it?Anaesthesia.2021 Apr;64(4):450-1,模拟训练,穿刺针运动跟踪技术,穿刺针增强技术,超声引导血管穿刺的标准方法,锁骨下静脉-选择探头,错误,正确,探头的使用不当,平面内&平面外,Anaesthesia 2021,63,P806-813,识别颈总动脉,显示穿刺针压迫静脉前壁的切迹,识别胸膜,识别椎动脉,CA,IJV,IJV,IJV,C6,C7,椎动脉管内段,椎动脉管外段,椎动脉横切面,左右颈内静脉的直径不同,静脉不充盈,局部血肿,颈内静脉导管,动、静脉重叠,IJV,CA,长颈，过伸 垫肩过度,横突前结节过长,动静脉间距增大,原因-血肿,CA,IJV,MISSION,IMPOSSIBLE ！,CA,颈部包块压迫静脉,超声实时引导的方法,常规消毒铺巾,探头置入无菌套,声学耦合,显示血管