Wireless Ultrasound-Guided Axillary Vein Cannulation for the Implantation of Cardiovascular Implantable Electric Devices
Wireless Ultrasound-Guided Axillary Vein Cannulation for the Implantation of Cardiovascular Implantable Electric Devices
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DOI：
10.1111/jce.12917
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发表时间：
2016-04-01
影响因子：
2.7
通讯作者：
Moreno, Javier
中科院分区：
文献类型：
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作者：
Franco, Eduardo;Rodriguez Munoz, Daniel;Moreno, Javier
背景超声引导血管插管似乎比解剖标志性方法更安全、更有效，但由于有线探头的工作流程干扰，该方法尚未得到广泛支持。无线超声换能器(WUST)可以解决这个问题。我们报告了人类首次在新型Wust引导下进行腋静脉插管植入心血管可植入电子设备(CIED)的有效性、时间消耗和安全性。方法和结果经过一个月的培训后，我们常规地对所有第一批植入物进行了Wust引导下的穿刺术，前瞻性地登记了前50名患者的数据。我们分析了准备Wust和实现每一次静脉插管所需的时间，以及不成功或意外的动脉穿刺率和并发症。50例患者中49例在Wust引导下腋下静脉插管成功，共86条插管静脉。中位Wust准备时间为55[44-62]秒，每次静脉插管中位时间为56[36-71]秒。一次置管成功率为84.9%。其中7例未成功，1例误穿动脉。在49名成功插管的患者中，没有发生气胸、血胸或神经损伤。未成功的一例(远端锁骨下动脉闭塞)发生了轻微的局部皮下气肿，没有确诊的放射学气胸，不需要干预。随访期2.5~1.1个月，1例发生口袋感染，无其他明显并发症。结论超声引导下应用无线换能器进行腋静脉置管是一种可行、快速、安全的方法。
Wireless Ultrasound-Guided Axillary Vein CannulationIntroductionUltrasound guidance for vascular cannulation seems safer and more effective than an anatomical landmark approach, though it has not gained widespread support partly due to workflow interference of wired probes. A wireless ultrasound transducer (WUST) may overcome this issue. We report the effectiveness, time consumption, and safety of the first-in-human experience in axillary vein cannulation guided with a novel WUST for the implantation of cardiovascular implantable electric devices (CIEDs).Methods and ResultsAfter a one-month training period, we routinely performed WUST-guided puncture to all first implants, prospectively registering data from the first 50 patients. We analyzed the time needed for preparing the WUST and for achieving each vein cannulation, and the rate of unsuccessful or accidental arterial punctures and complications. WUST-guided axillary vein access was successful in 49 out of 50 patients, totaling 86 cannulated veins. Median WUST preparation time was 55 [44-62] seconds and median time needed for each venous cannulation was 56 [36-71] seconds. A total of 84.9% of the veins were cannulated at the first attempt. There were 7 unsuccessful puncture attempts and 1 accidental arterial puncture. No pneumothorax, hemothorax, or nervous injury occurred in the 49 successfully cannulated patients. The unsuccessful one (distal subclavian occlusion) developed a minor local subcutaneous emphysema with no confirmed radiologic pneumothorax, not requiring intervention. During a follow-up of 2.5 1.1 months, a patient developed a pocket infection, with no other significant complications.ConclusionUltrasound-guided axillary vein cannulation using a wireless transducer for the implantation of CIEDs is a feasible, fast, and safe method.