锁骨上入路锁骨下静脉置管的流程与教学歌诀

Procedure and teaching verses of supraclavicular subclavian catheterization

为了提高锁骨上入路深静脉置管的操作成功率,减少机械并发症,本研究基于锁骨下静脉相对固定的毗邻解剖关系,对锁骨上入路深静脉置管的"标准流程"进行适当改进,提出一种锁骨上入路锁骨下静脉置管的辅助手法,并以歌诀形式加以总结归纳(歌诀:拇指定位寓妙算,针入静脉宜平穿。细针到位固定稳,伴行穿刺又何难?大针到位需测压,血管明辨命相关。导丝置入应顺畅,扩皮置管回血看。)。作为教学需要,歌诀形式更加简明扼要,便于记忆,也贴近手把手实战,以期为临床教学提供一定帮助。

In order to improve the success rate of supraclavicular deep venous catheterization and reduce mechanical complications,we present an auxillary maneuver in regard to supraclavicular subclavian catheterization basing on the relatively fixed anatomy of subclavian vein and its adjacent surroundings,furthermore,we revised the standardized procedure of supraclavicular subclavian catheterization.The maneuver is summarized in the shape of verses(verses:thumb navigation is well designed according to anatomy.Needle penetrated into vein should be parallel to coronal plane.Fine needle in position should be immobilized.Is it difficult for parallel puncture?Pressure determination is required when needle is in place.It is critical to distinguish which vessel has been inserted.Guidewire is advanced smoothly.Check blood return after expansion of skin and catheterization.).For teaching convenience,verses are considered to be more concise and memorable,as well as applicable to clinical practice,in order to provide some help for clinical teaching.