透视引导儿童右锁骨下静脉穿刺置管方法

Fluoroscopy-guided children's right subclavian vein puncture and catheterization

目的:回顾性分析儿童右侧锁骨下静脉(RSV)的解剖特点,探讨X线引导下行儿童RSV穿刺置管方法,并评价其可行性和安全性。方法:50例患儿,经右手留置针行RSV X线造影,观察RSV X线解剖位置、走行及其与右侧锁骨头的关系。根据观察结果,临床上透视下按骨性标志行小儿RSV穿刺166例。统计穿刺成功率、穿刺次数、穿刺时间、X线计量、导管尖端位置及穿刺并发症。结果:RSV较固定地走行于锁骨头的胸锁关节面连线的中点及附近。X线导引下小儿右侧锁骨下静脉穿刺成功率100%;穿刺次数为:1.0±0.4,其中一次性穿刺成功160次,一次成功率96%;穿刺时间:(0.8±0.9)min;并发症5例,其中误入颈内静脉2例,局部血肿3例;X线计量为(1.5±2.4)m Gy。结论:X线引导下按骨性标志行儿童RSV穿刺置管术是安全且一次穿刺成功率高的方法。

Objective To discuss on the X-ray-guided children＇s fight subclavian vein （RSV） puncture and catheterization, and evaluate its feasibility and safety by retrospectively analyzing the anatomical features of children＇s RSV. Methods Fifty children patients underwent catheterization through the right hand and RSV X-ray contrast to observe the RSV X-ray anatomical position, course and the relationship with RS head. The observations showed 166 cases were clinically fluoroscopy- guided RSV puncture following the bone marks. The puncture success rate, puncture frequency, puncture time, X-ray measurement, catheter tip position and puncture complications were statistically analyzed. Results RSV were basically around the midpoint of connection of stemoclavicular joint surface. The success rate of X-ray-guided RSV puncture was 100%, and puncture frequency was 1.0±0.4. Among them, 160 first punctures were successful, with success rate of 96%. The puncture time was （0.8± 0.9） min. And complications were appeared in 5 cases, with 2 cases of internal jugular vein strayed and 3 cases of hematoma. X-ray measurement was （1.5±2.4） mGy. Conclusion X-ray-guided children＇s RSV puncture and catheterization following bone marks is a safe method with a high success rate of first puncture.