Iwasaki T, Hayashi Y, Ohnishi Y, Kuro M
Department of Anesthesiology, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita Osaka 565-0873, Japan.
Pediatr Cardiol. 2004 Sep-Oct;25(5):503-5. doi: 10.1007/s00246-003-0643-8. Epub 2004 Apr 2.
Our previous study showed that the success rate of cannulation of the internal jugular vein (IJV) was significantly decreased in infants weighing less than 4.0 kg. We prospectively evaluated results of central venous catheterization in 101 infants weighing less than 4.0 kg undergoing cardiac surgery. The first attempt was routinely performed on the right IJV. If the first attempt failed, the anesthesiologist was free to choose the cannulation site. We examined the effects of patient weight and the experience of the anesthesiologist on successful central catheterization and efficacy of the external jugular vein (EJV) if the first attempt failed. The first right IJV cannulation was successful in 53 infants (52.5%) and the overall successful catheterization rate was 82.2%. Success rates of cannulation of the right IJV, left IJV, and EJV were 64, 13, and 6%, respectively. Body weight contributed significantly to successful catheterization, but the experience of the anesthesiologist did not. These results suggest that EJV cannulation improves the successful central catheterization in infants weighing less than 4.0 kg if IJV cannulation fails. Body weight of an infant, but not the experience of the anesthesiologist, contributed to successful catheterization in this patient population.
我们之前的研究表明，体重小于4.0 kg的婴儿颈内静脉（IJV）置管成功率显著降低。我们前瞻性评估了101例体重小于4.0 kg接受心脏手术的婴儿中心静脉置管的结果。首次尝试常规在右侧IJV进行。如果首次尝试失败，麻醉医生可自由选择置管部位。我们研究了患者体重和麻醉医生经验对中心静脉置管成功的影响，以及首次尝试失败时颈外静脉（EJV）置管的效果。首次右侧IJV置管成功53例（52.5%），总体置管成功率为82.2%。右侧IJV、左侧IJV和EJV置管成功率分别为64%、13%和6%。体重对置管成功有显著影响，但麻醉医生的经验没有。这些结果表明，如果IJV置管失败，EJV置管可提高体重小于4.0 kg婴儿的中心静脉置管成功率。在这一患者群体中，婴儿体重而非麻醉医生经验对置管成功有影响。
