Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （...Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.展开更多
Background Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fl...Background Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated. Methods Anatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation. Results The anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2±10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: χ 2=626.642, P <0.01; complication rate: χ 2=80.708, P <0.01). Conclusions The modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.展开更多
Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein...Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.展开更多
目的：探讨彩色多普勒超声引导锁骨下静脉穿刺术对临床需多次重复置管患者的应用价值及安全性。方法对3380例在超声科实施彩超引导锁骨下静脉穿刺置管患者的临床资料进行回顾性分析，按置管需求次数归类为A组（首次置管）、B组（重复置...目的：探讨彩色多普勒超声引导锁骨下静脉穿刺术对临床需多次重复置管患者的应用价值及安全性。方法对3380例在超声科实施彩超引导锁骨下静脉穿刺置管患者的临床资料进行回顾性分析，按置管需求次数归类为A组（首次置管）、B组（重复置管2~3次）及C组（重复置管4次及以上）。观察各组总成功率及穿刺一次成功率、并发症种类及发生率等，并进行统计比较。结果3380例患者中，首次置管A组1644例，穿刺一次成功、穿刺两次及以上成功分别为1556例（94.6％）和87例（5.3％），失败1例，总成功率99.9％；重复置管B组1224例，穿刺一次成功、穿刺两次及以上成功分别为1148例（93.8％）和75例（6.1％），失败1例，总成功率为99.9％；多次置管C组512例，穿刺一次成功、穿刺两次及以上成功分别为438例（85.5％）和69例（13.5％），失败5例，总成功率99.0％；与A、B两组相比，C组的穿刺总成功率、一次成功率较低，差异具有统计学意义（ P 〈0.01）。三组共发生穿刺并发症29例，总发生率0.9％，其中C组并发症发生率（12/512，2.3％）明显高于A组（9/1644，0.5％）和B组（8/1224，0.7％），差异有非常显著性（ P 〈0.01）。另外，穿刺过程中导丝误入颈内静脉共541例，占16.0％，三组分别为279（16.8％）、185（14.9％）、77（15.0％）例，组间比较其发生率无显著差异（ P 〉0.05）。结论彩色多普勒超声引导锁骨下静脉穿刺置管术简便、安全，置管成功率高，尤其对于临床需多次重复置管的患者（如恶性肿瘤化疗、肥胖、胸廓畸形、水肿等），同样效果可靠。术前、术中仔细探查可减少置管失败和穿刺并发症的发生，对提高临床救治质量，降低医疗风险具有较高应用价值。展开更多
基金Project supported by the National Natural Science Foundation of China(Nos.81501644,81471623,81130007,81270446,and 30801188)the Key Science and Technology Innovation Team Project of the Science and Technology Department of Zhejiang Province(No.2011R50018-16),China
文摘Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.
文摘Background Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated. Methods Anatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation. Results The anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2±10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: χ 2=626.642, P <0.01; complication rate: χ 2=80.708, P <0.01). Conclusions The modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.
文摘Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.
文摘目的：探讨彩色多普勒超声引导锁骨下静脉穿刺术对临床需多次重复置管患者的应用价值及安全性。方法对3380例在超声科实施彩超引导锁骨下静脉穿刺置管患者的临床资料进行回顾性分析，按置管需求次数归类为A组（首次置管）、B组（重复置管2~3次）及C组（重复置管4次及以上）。观察各组总成功率及穿刺一次成功率、并发症种类及发生率等，并进行统计比较。结果3380例患者中，首次置管A组1644例，穿刺一次成功、穿刺两次及以上成功分别为1556例（94.6％）和87例（5.3％），失败1例，总成功率99.9％；重复置管B组1224例，穿刺一次成功、穿刺两次及以上成功分别为1148例（93.8％）和75例（6.1％），失败1例，总成功率为99.9％；多次置管C组512例，穿刺一次成功、穿刺两次及以上成功分别为438例（85.5％）和69例（13.5％），失败5例，总成功率99.0％；与A、B两组相比，C组的穿刺总成功率、一次成功率较低，差异具有统计学意义（ P 〈0.01）。三组共发生穿刺并发症29例，总发生率0.9％，其中C组并发症发生率（12/512，2.3％）明显高于A组（9/1644，0.5％）和B组（8/1224，0.7％），差异有非常显著性（ P 〈0.01）。另外，穿刺过程中导丝误入颈内静脉共541例，占16.0％，三组分别为279（16.8％）、185（14.9％）、77（15.0％）例，组间比较其发生率无显著差异（ P 〉0.05）。结论彩色多普勒超声引导锁骨下静脉穿刺置管术简便、安全，置管成功率高，尤其对于临床需多次重复置管的患者（如恶性肿瘤化疗、肥胖、胸廓畸形、水肿等），同样效果可靠。术前、术中仔细探查可减少置管失败和穿刺并发症的发生，对提高临床救治质量，降低医疗风险具有较高应用价值。
