锁骨上新进路行锁骨下静脉置管在小儿的应用

A new approach for subclavicular vein catheterization in children and infants

目的探讨锁骨上锁骨中点内侧为进针点新进路行经皮锁骨下静脉置管用于小儿的可行性与技术特点.方法1个月～12岁小儿128例,ASA Ⅰ～Ⅱ级,按年龄分为四组.以锁骨中点内侧0.5 cm锁骨上0.5～1 cm为进针点,针体与矢状面成45～50度角,与冠状面成负10～15度角,针尖指向锁骨内1/3段中点.采用Sledinger法置入中心静脉导管.结果总穿刺成功率99.22%,一次试穿成功率87.5%.进针点至锁骨内1/3段中点的距离为(2.62±0.68)cm,进针深度为(2.28±0.68)cm,中心静脉置管成功率100%.32例颈胸部X线片示:导管尖端位于右房口21例,位于上腔静脉下段11例.无气胸、误穿动脉、神经损伤等并发症.结论锁骨上锁骨中点内侧新进路行锁骨下静脉置管标志清楚,定位明确,穿刺置管成功率和一次试穿成功率高,并发症少,可适用于小儿.

Objective To evaluate the feasibility of a new supraclavitular approach for percuta- neous subclavicular vein catheterization in children and infants. Methods According to the age, 128 infants and children,aged 1 month to 12 years, ASA Ⅰ- Ⅱ , were randomly divided into four groups. The puncture point located about 0. 5 cm inside the median of the clavicle, and 0. 5-1 cm above of the clavicle. The needle was advanced towards the middle of the one-third inside the clavicle along with edge of the clavicle with a 45-50 degrees with arrowy plane and minus 10-15 degrees with coronary plane. The central venous catheter was placed by Seldinger. Result The total successful rate of puncture was 99.22% ,and 87.5% of the cases was punctured successfully at the first attempt. The distance from puncture point to the middle of one-third inside the clavicle was（2.62±0.68） cm. The depth of puncture was（2.62±0.68） cm. The successful rate of catheterization was 100%. The tips of catheter were shown by X-radiography in the inlet of the right atrium in 21 cases, and in the inferior segment of the superior vena cava in 11 cases. No complications of pneumothorax, arterial puncture and nervous in jury occurred. Conclusion The new approach mentioned above is reliable and safe in children and infants.