Murphy Glenn S, Szokol Joseph W, Marymont Jesse H, Avram Michael J, Vender Jeffery S, Kubasiak John
Department of Anesthesiology, Evanston Northwestern Healthcare, IL 60201, USA.
Anesthesiology. 2006 Sep;105(3):492-7. doi: 10.1097/00000542-200609000-00012.
Flushing of radial arterial catheters may be associated with retrograde embolization of air or thrombus into the cerebral circulation. For embolization into the central circulation to occur, sufficient pressure must be generated during the flushing process to reverse antegrade blood flow in the arterial blood vessels of the upper extremity. This ultrasound study was designed to examine whether routine radial catheter flushing practices produce retrograde blood flow patterns in the brachial and proximal axillary arteries.
Duplex ultrasound examinations of the brachial and axillary arteries were conducted in 100 surgical patients to quantify direction and velocity of blood flow during catheter flushing. After obtaining Doppler spectral images of brachial and axillary arterial flow patterns, manual flushing was performed by injecting 10 ml flush solution using a syringe at a rate reflecting standard clinical practices. The flow-regulating device on the pressurized (300 mmHg) arterial flushing-sampling system was then opened for 10 s to deliver a rapid bolus of fluid (flush valve opening).
The rate of manual flush solution injection through the radial arterial catheter was related to the probability of retrograde flow in the axillary artery (P < 0.001). Reversed arterial flow was noted in the majority of subjects (33 of 51) at a manual flush rate of less than 9 s and in no subjects (0 of 48) at a rate 9 s or greater. Retrograde flow was observed less frequently during flush valve opening (2 of 99 patients; P < 0.001 vs. manual flushing).
Rapid manual flushing of radial arterial catheters at rates faster than 1 ml/s produces retrograde flow in the proximal axillary artery.
桡动脉导管冲洗可能与空气或血栓逆行栓塞入脑循环有关。要发生栓塞进入中心循环，冲洗过程中必须产生足够的压力以逆转上肢动脉血管中的顺行血流。本超声研究旨在检查常规桡动脉导管冲洗操作是否会在上臂和近端腋动脉中产生逆行血流模式。
对100例外科手术患者的肱动脉和腋动脉进行双功超声检查，以量化导管冲洗期间血流的方向和速度。在获得肱动脉和腋动脉血流模式的多普勒频谱图像后，按照反映标准临床操作的速率，用注射器注入10 ml冲洗液进行手动冲洗。然后打开加压（300 mmHg）动脉冲洗采样系统上的流量调节装置10 s，以输送快速推注的液体（冲洗阀打开）。
通过桡动脉导管手动注入冲洗液的速率与腋动脉逆行血流的可能性相关（P < 0.001）。在大多数受试者（51例中的33例）中，手动冲洗速率小于9 s时出现了反向动脉血流，而在冲洗速率为9 s或更高时，没有受试者（48例中的0例）出现反向血流。在冲洗阀打开期间，观察到逆行血流的频率较低（99例患者中有2例；与手动冲洗相比，P < 0.001）。
以高于1 ml/s的速率快速手动冲洗桡动脉导管会在近端腋动脉中产生逆行血流。
