Optimal site for ultrasound-guided venous catheterisation in paediatric patients: an observational study to investigate predictors for catheterisation success and a randomised controlled study to determine the most successful site.
Optimal site for ultrasound-guided venous catheterisation in paediatric patients: an observational study to investigate predictors for catheterisation success and a randomised controlled study to determine the most successful site.
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DOI：
10.1186/s13054-014-0733-4
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发表时间：
2015-01-20
期刊：
影响因子：
--
通讯作者：
Mizobe T
中科院分区：
文献类型：
--
作者：
Takeshita J;Nakayama Y;Nakajima Y;Sessler DI;Ogawa S;Sawa T;Mizobe T
儿科患者静脉置管在技术上具有挑战性。我们检查了影响儿童看不见和摸不着周围静脉置管的因素，并评估了超声引导下置管的最佳位置。测定96例体重小于20 kg的儿童的收缩压、年龄、性别和美国麻醉医师协会（ASA）的身体状况。超声测量静脉内径和皮下深度。采用Logistic回归评价这些因素对超声引导下（n = 65）或不（n = 31）插管成功的贡献。随后，我们随机选取196例患者，分别在手背静脉、前臂头静脉或大隐静脉置入静脉导管。采用Dunn试验评估成功率和静脉直径；采用Kaplan-Meier累积发生率分析评价插入时间。导管置入术的独立预测因子为超声引导(优势比（OR) = 7.3, 95%可信区间（CI） 2.0 ~ 26.0, P = 0.002）、静脉直径（OR = 1.5 /直径增加0.1 mm, 95% CI 1.1 ~ 2.0, P = 0.007）和ASA身体状态（OR = 0.4 /状态增加1 mm， 95% CI 0.2 ~ 0.9, P = 0.03）。头静脉明显增大（头静脉直径1.8 mm, P = 0.001，相比隐静脉直径1.5 mm, P <0.001，相比背静脉直径1.5 mm）。头静脉置管成功率明显优于手背静脉或隐静脉（头静脉95%，95% CI 89%至100%，P <0.001，背静脉69%，95% CI 56%至82%，P = 0.03，隐静脉75%，95% CI 64%至86%）。前臂近端头静脉似乎是超声引导下对儿科患者进行看不见和摸不到静脉置管的最合适的初始位置。UMIN临床试验注册编号为UMIN000010961。于2013年6月14日注册。
Venous catheterisation in paediatric patients can be technically challenging. We examined factors affecting catheterisation of invisible and impalpable peripheral veins in children and evaluated the best site for ultrasound-guided catheterisation. Systolic pressure, age, sex, and American Society of Anaesthesiologists (ASA) physical status were determined in 96 children weighing less than 20 kg. Vein diameter and subcutaneous depth were measured with ultrasound. Logistic regression was used to evaluate the contribution of these factors to cannulation success with (n = 65) or without (n = 31) ultrasound guidance. Thereafter, we randomly assigned 196 patients for venous catheter insertion in the dorsal veins of the hand, the cephalic vein in the forearm, or the great saphenous vein. Success rates and vein diameters were evaluated by using Dunn tests; insertion time was evaluated by using Kaplan-Meier cumulative incidence analysis. Independent predictors of catheterisation were ultrasound guidance (odds ratio (OR) = 7.3, 95% confidence interval (CI) 2.0 to 26.0, P = 0.002), vein diameter (OR = 1.5 per 0.1 mm increase in diameter, 95% CI 1.1 to 2.0, P = 0.007), and ASA physical status (OR = 0.4 per status 1 increase, 95% CI 0.2 to 0.9, P = 0.03). Cephalic veins were significantly larger (cephalic diameter 1.8 mm, P = 0.001 versus saphenous 1.5 mm, P <0.001 versus dorsal 1.5 mm). Catheterisation success rates were significantly better at the cephalic vein than either the dorsal hand or saphenous vein (cephalic 95%, 95% CI 89% to 100%, P <0.001 versus dorsal 69%, 95% CI 56% to 82%, P = 0.03 versus saphenous 75%, 95% CI 64% to 86%). The cephalic vein in the proximal forearm appears to be the most appropriate initial site for ultrasound-guided catheterisation in invisible and impalpable veins of paediatric patients. UMIN Clinical Trials Registry as UMIN000010961. Registered on 14 June 2013.
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