锁骨下静脉穿刺置管术在神经外科重症患者的应用的临床效应(附300例病例报告)

The Experience of Subclavian Vein Catheter Paracentesis Application in the Severe Nerve Surgery Disease(With 300 cases of medical)

目的:分析探讨锁骨下静脉穿刺置管术在重症神经外科疾病中的应用的临床效应。方法:选择锁骨下静脉,首选右侧,如果穿刺右侧失败改为左侧。穿刺成功后用扩张器扩皮,最后顺导丝置入导管,根据患者身高置管长度为12～15 cm,局部缝合固定,外敷纱布封闭或用一次性贴膜封闭。静脉留置管接三通静脉输液管。结果:286例首次穿刺右侧成功282例,4例失败后改选左侧成功。静脉导管留置时间最短3天,最长45天,留置时间平均为18天。结论:锁骨下静脉穿刺置管术在神经外科中抢救治疗重症患者是十分便利、有效的措施。锁骨下静脉穿刺置管术较其他深静脉穿刺置管如股静脉、颈内静脉和颈外静脉穿刺置管术及PICC相比较,更利于护理并具有费用低廉的优点。其方便、有效、经济的特点十分利于临床应用。

Objective： To analyze the experience of subclavian vein catheter paracentesis application in the severe neurosurgery disease.Methods： We chose the subclavian vein in the clinical work.First,it should be performed on the right side,or turn to the left if the right side was failed.After the success of the paracentesis we extend skin with expandor,and insert catheter along guidewire,length of catheter for 12 to 15 cm according to patients’height,then suture fixation,connect the intravenous catheter with Y-section.Results： 282 cases were successful at first time on the right side in 286 cases,4 cases failed turn to success after turn to the left.The time of indwelling venous catheter from shortest three days to the longest 45 days,the average time is 18 days.Conclusion： Subclavian vein paracentesis is very convenient and effective measure in the severe neurosurgery disease.And the subclavian vein paracentesis is more benefit at the nursing processes and the advantage of low cost compared with other deep venipuncture,such as jugular vein,external jugular vein,femoral vein,PICC,etc.It is convenient,effective and economic in clinical application.