术中超声探查锁骨下静脉内导引导丝在PICC穿刺误入肱动脉中的判断作用

Ultrasound exam for differentiating guidewire＇s misplacement into brachial artery during PICCinsertion through subclavian vein

目的介绍一种PICC置管术中使用超声探查判断有无误穿肱动脉的检查方法。方法选择145例置管患者为研究对象，在穿刺成功，送入导引导丝后，使用超声探查锁骨下静脉内导引导丝显影情况，即时判断有无误穿肱动脉，术中使用腔内心电图定位，术后使用X线胸片定位加以验证。结果144例患者在锁骨下静脉内观察到导引导丝显影，1例在锁骨下动脉内观察到导引导丝显影，证实误入肱动脉1例，即时拔出导引导丝，适当按压，仅有穿刺点周边青紫，无活动性出血，对患者损伤小。结论术中使用超声探查锁骨下静脉内导引导丝显影，可即时鉴别是否误入肱动脉，避免送入导管后引起的诸多并发症，操作简便，值得临床推广。

Objective Introducing ultrasound exam method for detecting accidental displacement of guidewire into brachial artery during one type of PICC placement. Methods Select 145 patients with PICC placement as objects of study. During procedure, use EKG guidance for localization. Aftersuccessfully inserted the needle into a vein and threaded the guidewire through the needle, then apply ultrasound to show the guidewire image to verify whether or not the guidewire is advanced into braehial artery at any moment. After the procedure, a chest X-ray is taken for location confirmation. Results 144 patient＇s guidewire ultrasound images were seen inside the subclavian vein. One patient＇s guidewire ultrasound image was shown inside the subclavian artery, which confirms it was accidentally advanced into the brachial artery during insertion. The guidewire was removed immediately, only scant bleeding occurred. Conclusions By utilizing ultrasound to show the guidewire image inside subclavian vein, it will help differentiate if it is accidentally advanced into the braehial artery at any moments during PICC insertion. It assists avoiding complications after advancing the catheter. It is easy to perform and helpful for wide clinical use.