两种留置针穿刺角度配合不同对比剂注射速率在减少对比剂外渗中的效果研究

Study on the effect of two kinds of indwelling needle puncture angle combined with different injection rate of contrast medium in reducing the extravasation of contrast medium

目的利用体外静脉穿刺模型,模拟探究留置针不同进针角度与速率的相关性。方法采用8套前臂静脉穿刺模型在45°、60°两种留置针进针手法穿刺下,分别配合3 mL/s、4 mL/s、5 mL/s、6 mL/s速率高压团注对比剂,CT断层扫描采集数据并结合VR重建,观察针尖在血管内是否存在深入或回退情况。结果(1)60°进针时,随对比剂流速增加,模拟血管内针尖均出现不同程度的深入,深入范围为0.14~1.57 mm(P<0.05)。(2)45°进针时,针尖变化不显著(流速≤4 mL/s),针尖明显从模拟血管内回退(流速>4 mL/s),回退范围为0.14~0.22 mm。结论当造影剂流速≤4 mL/s时,宜选择45°进针;当造影剂流速为5 mL/s时宜选择60°进针;当造影剂流速为6 mL/s时选择45°会造成进针回退,选择60°进针会造成进针深入。建议临床上结合患者血管条件辅助决策,在一定的流速下,血管条件好宜选择45°进针,血管条件欠佳宜选择60°进针。

Objective To study the correlation between the puncture technique of 60°and 45°and the rate of contrast medium injected by high pressure CT with veni puncture model in vitro.Methods Eight venous puncture models were punctured in 2 injection techniques,with 3 mL/s,4 mL/s,5 mL/s and mL/s rate.CT tomography data was collected and combined with VR reconstruction,to determine whether the needle tip in the blood vessels out of the situation.Results When 60°injection,with the increase of contrast agent flow rate,the needle tip in the simulated blood vessels appears in varying degrees of depth,range 0.14~1.57 mm(P<0.05).When 45°injection is entered,the flow rate is not significant when the flow rate≤4 mL/s,and when the flow rate>4 mL/s,the needle tip is obviously removed from the simulated blood vessel,range 0.14~0.22 mm,(P<0.05).Conclusion Under the condition of constant flow rate,45°needle was selected for good vascular condition,and 60°needle was selected for poor vascular condition.