通过体表标志估测深静脉导管留置的合适深度

Estimation of insertion depth of central venous catheterizationby body surface marker

目的探索通过体表标记测量来估测深静脉导管留置合适深度(上腔静脉与右心房的联结处或者气管隆突水平)的简易方法。方法通过左、右颈内静脉,左、右锁骨下静脉通路放置中心静脉导管。穿刺前通过体表标记测量估测导管可能留置深度:穿刺点至右侧锁骨上切迹的距离+右锁骨上切迹至胸骨角距离,其中左锁骨下穿刺时需再减去2.00 cm。穿刺完毕通过床旁胸片检测导管尖端与隆突水平间的距离。尖端高于隆突水平为正,低于隆突水平为负值。结果 86名患者,共100条深静脉纳入研究,各组静脉导管尖端与隆突水平间距离的中位数与四分位数间距:右颈内静脉导管组为0.50 cm与1.10 cm;右锁骨下静脉导管组为0.50 cm与1.30 cm;左颈内静脉导管组为0.60 cm与1.45 cm;左锁骨下静脉导管组为-0.30 cm与1.50 cm。结论通过深静脉估算方法:穿刺点至右侧锁骨上切迹的距离+右锁骨上切迹至胸骨角距离,其中左锁骨下穿刺时需再减去2.00 cm。中心静脉导管的尖端能较可靠的放置于气管隆突水平。

Objective To estimate the insertion depth of central venous catheterization （CVC） by body surface marker. Methods CVC was peribmled via right/left internal jugular vein （IJV） or right/left subclavian vein （SCV）. The CVC was placed at a depth derived by adding the length between the needle insertion point and the right clavicular notch and the vertical length between the clavicular notch and sternal angle. The distance between CVC tip and carina was measured on the postoperative chest radio- graph. Results Totally 100 deep veins of 86 patients were included in the study. Tlle distances（ median and quartile） between CVC tip and carina were 0.50 vs 1.10 cm in right IJV group, 0.50 vs 1.30 cm in right SCV group, 0.60 vs 1.45 cm in left IJV and -0.30 vs 1.50 cm. Conclusion Prediction of CVC depth derived by adding the length between needle insertion point and ! clavicular notch and the vertical length between clavicular notch and sternal angle （nlinus 2.00 cm for left SCV）, the CVC tip may be reliably placed near the carina level.