Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room o...Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.展开更多
BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage ...BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.展开更多
BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SU...BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.展开更多
We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases wi...We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.展开更多
Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically...Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.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:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超...目的:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超声仪实时引导下,均经颈内静脉采用Seldinger技术加撕脱型扩张导管置管法植入永久性血液透析导管.分析记录穿刺次数、手术成功率、手术时间以及术后并发症的发生率.并将患者分为一般患者及高危患者两组进行对比,曾经有过颈内静脉临时置管或曾经有过置管困难情况或配合差、肥胖、衰弱、骨骼畸形及凝血功能异常者为高危患者.结果:全部患者采用实时超声引导经颈内静脉留置永久性导管成功率100％,其中高危患者20例(31.7％);有60例患者一次性置管成功(95.2％);穿刺次数1～3(1.23±0.21)次;3例患者出现术中即刻并发症(4.7％);在使用过程中导管感染3例(4.7％).手术时间高危组患者长于一般患者组[(30.6±0.11) min vs (19.1±0.09) min,P＜0.05];两组在穿刺次数,置管成功率、术中并发症方面的差异无统计学意义(P＞0.05);但高危组(4/20,20％)在长期使用导管过程更易因导管血栓形成而导致流量不佳.结论:采用超声引导下颈内静脉留置永久性双腔导管是一种安全、有效的血管通路技术,成功率高;不论在高危患者还是一般患者中都具有操作简单、并发症少的特点,值得在临床广泛推广.展开更多
文摘Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.
文摘BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.
文摘BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.
文摘We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.
文摘Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.
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:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超声仪实时引导下,均经颈内静脉采用Seldinger技术加撕脱型扩张导管置管法植入永久性血液透析导管.分析记录穿刺次数、手术成功率、手术时间以及术后并发症的发生率.并将患者分为一般患者及高危患者两组进行对比,曾经有过颈内静脉临时置管或曾经有过置管困难情况或配合差、肥胖、衰弱、骨骼畸形及凝血功能异常者为高危患者.结果:全部患者采用实时超声引导经颈内静脉留置永久性导管成功率100％,其中高危患者20例(31.7％);有60例患者一次性置管成功(95.2％);穿刺次数1～3(1.23±0.21)次;3例患者出现术中即刻并发症(4.7％);在使用过程中导管感染3例(4.7％).手术时间高危组患者长于一般患者组[(30.6±0.11) min vs (19.1±0.09) min,P＜0.05];两组在穿刺次数,置管成功率、术中并发症方面的差异无统计学意义(P＞0.05);但高危组(4/20,20％)在长期使用导管过程更易因导管血栓形成而导致流量不佳.结论:采用超声引导下颈内静脉留置永久性双腔导管是一种安全、有效的血管通路技术,成功率高;不论在高危患者还是一般患者中都具有操作简单、并发症少的特点,值得在临床广泛推广.
