Ultrasound guidance improves safety and efficiency of central line placements
Ultrasound guidance improves safety and efficiency of central line placements
复制标题
DOI：
10.1016/j.jpedsurg.2018.08.039
复制
发表时间：
2019-08-01
影响因子：
2.4
通讯作者：
Jarboe, Marcus D.
中科院分区：
文献类型：
--
作者：
Criss, Cory N.;Gadepalli, Samir K.;Jarboe, Marcus D.
背景：使用超声引导成人中心静脉通路是护理标准。然而，常规超声在儿童静脉通路中的作用尚不明确。我们试图评估在儿科患者中使用超声引导方法与传统的标志性方法相比，使用超声引导方法放置中心静脉导管的安全性和效率。研究设计：使用 CPT 代码，对同一儿科手术组在 2005 年至 2017 年间对所有儿童隧道式中心静脉导管进行了单机构回顾性图表审查。在研究期间，实践发生了变化，从完全基于标志的线放置到超声引导线放置。各组分为三个阶段：传统/标志性时代（第一阶段）、过渡时期（第二阶段）和超声时代（第三阶段）。分析的主要结果是术后胸管插入情况和手术时间。 结果：总共纳入 2010 条隧道式中心导管进行分析：第 1 期 (N = 930)、第 2 期 (N = 313) 和第 3 期 (N = 767)。化疗的静脉通路是最常见的适应症（29%）。第一阶段的胸管置入率为 9.7/1000 例手术，第二阶段的置管率为 6.4/1000 例手术，第三阶段没有胸管插入 (p = 0.009)。与第 2 阶段（57 分钟 vs. 49 分钟，p < 0.0026）和第 3 阶段（57 分钟 vs. 46 分钟，p < 0.001）相比，第 1 阶段的手术时间更长。结论：这项研究代表了对儿童超声引导通路的最大分析。在两年内完成向超声引导方法的实践过渡是可行的。与传统的、具有里程碑意义的儿童技术相比，超声引导方法的手术时间更短，胸管插入次数更少。 (C) 2018 Elsevier Inc. 保留所有权利。
Background: Use of ultrasound-guidance for central venous access in adults is the standard of care. There is, however, less clarity in the role of routine ultrasound use in obtaining venous access in children. We sought to evaluate safety and efficiency of the placement of central lines utilizing an ultrasound-guided approach compared to the traditional, landmark approach in pediatric patients.Study design: A single-institution retrospective chart review, using CPT codes, was performed for all tunneled central venous catheters in children between 2005 and 2017 by the same pediatric surgery group. During the study period, a practice change occurred from exclusively landmark-based line placement to ultrasound-guided line placement. Groups were divided into three phases: a traditional/landmark era (Phase 1), transitional period (Phase 2), and the ultrasound era (Phase 3). The primary outcomes analyzed were postoperative chest tube insertions and operative time.Results: A total of 2010 tunneled central lines were included for analysis: Phase 1 (N = 930), Phase 2 (N = 313) and Phase 3 (N = 767). Venous access for chemotherapy was the most common indication (29%). Phase 1 had a chest tube placement rate of 9.7/1000 procedures, while Phase 2 had a rate of 6.4/1000 procedures, and Phase 3 had no chest tube insertions (p = 0.009). Phase 1 had longer OR times compared to Phase 2 (57 vs. 49, p 0.0026) and Phase 3 (57 vs. 46 min, p < 0.001).Conclusions: This study represents the largest analysis of ultrasound-guided access for children. A complete practice transition to the ultrasound-guided approach was feasible within a two-year period. The ultrasound-guided approach had a shorter operative time and less chest tube insertions than the traditional, landmark technique in children. (C) 2018 Elsevier Inc. All rights reserved.