Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach
Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach
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DOI：
10.1093/bja/aem041
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发表时间：
2007-04-01
影响因子：
9.8
通讯作者：
Veyckemans, F.
中科院分区：
文献类型：
--
作者：
Pirotte, T.;Veyckemans, F.
背景即使对于经验丰富的儿科麻醉师来说，婴儿中心静脉插管仍然具有挑战性。超声（US）引导技术已被证明是颈内静脉导管插入术更安全。但锁骨下静脉（SCV）往往是儿童长期中心静脉置管的首选部位。我们描述了一种新的超声引导下婴幼儿SCV插管方法。该技术的原理是将超声探头放置在锁骨上水平，以获得SCV的纵向视图，并通过通常的锁骨下路径进入静脉，在超声控制下对其进行插管。这种技术的细节和陷阱进行了说明。我们的前25次穿刺的前瞻性收集的结果进行了记录。患者的体重和年龄范围分别为2.2-27 kg和1天至9岁：76%的儿童体重低于10 kg。第一次尝试的成功率为84%，两次尝试后的成功率为100%。SCV中的无症状血栓也可通过该技术检测到。这种超声引导下的SCV入路为儿童中心静脉导管插入术提供了新的可能性。这种技术似乎对10公斤以下的儿童很有希望，对年龄较大的儿童也可能有希望。它提供了高质量的针头引导，并允许在穿刺前检查血管通畅性。
Background. Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. We describe a novel US-guided approach for SCV cannulation in infants and children.Methods. The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein via the usual infraclavicular route to cannulate it under ultrasonic control. Details and pitfalls of this technique are described. The prospectively collected results of our first 25 punctures are reported.Results. Patients' weight and age range were 2.2-27 kg and 1 day to 9 yr, respectively: 76% of the children weighed less than 10 kg. The success rate at the first attempt was 84% and 100% after two attempts. An asymptomatic thrombus in the SCV could also be detected with this technique.Conclusions. This US-guided approach of the SCV offers a new possibility for central venous catheterization in children. This technique seems promising for children less than 10 kg and probably also for older children. It provides good quality needle guidance and allows to check the vessel patency before puncture.