特殊体位患者颈内静脉置管策略

Strategies of internal jugular vein catheterization for patients with special position

目的探讨特殊体位患者行颈内静脉置管的可行性和临床效果。方法对47例特殊体位(被动体位9例,强迫体位38例)下行颈内静脉置管的患者作好物品与患者准备,根据不同体位确定穿刺步骤和固定导管。结果 47例颈内静脉置管均成功,其中一次置管成功38例。中心静脉置管留置4~151d,中位数22d。留置过程中无与置管相关的不良反应或并发症发生。结论对特殊体位患者行颈内静脉置管需重视各操作环节,尤其是穿刺点定位、穿刺方向、穿刺深度及角度,以提高置管成功率,减少置管相关并发症的发生。

Objective To explore the feasibility and clinical effect of internal jugular vein catheterization for patients with special posi tion. Methods A total of 47 patients with special position （9 patients with passive position, 38 patients with compulsive position） and objects were well prepared for internal jugular vein catheterization, the puncture procedure and how to fix catheter were deter mined by patients＇ position. Results Internal jugular vein catheterization for the 47 patients were successful, and 38 of them were successful at the first attempt. The indwelling time of central venous catheter was 4-151 d （median 22 d）, and there were not catheter induced adverse reactions or complications. Conclusion Each operation link of internal jugular vein catheterization for pa- tients with special position should be paid attention, especially the location, direction, depth and angle of the puncture point, so as to improve the success rate of catheterization, and reduce catheter related complications.