Pirotte T, Veyckemans F
Department of Anaesthesia, Université Catholique de Louvain, Cliniques universitaires St-Luc, Brussels, Belgium.
Br J Anaesth. 2007 Apr;98(4):509-14. doi: 10.1093/bja/aem041. Epub 2007 Mar 1.
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.
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.
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.
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.
即使对于经验丰富的儿科麻醉医生来说，婴儿的中心静脉置管仍然具有挑战性。超声（US）引导技术已被证明用于颈内静脉置管更安全。但锁骨下静脉（SCV）通常是儿童长期中心静脉置管的首选部位。我们描述了一种用于婴儿和儿童SCV置管的新型超声引导方法。
该技术的原理是将超声探头置于锁骨上水平以获得SCV的纵向视图，并通过通常的锁骨下途径进入静脉，在超声控制下进行置管。描述了该技术的细节和陷阱。报告了我们前25次穿刺的前瞻性收集结果。
患者体重和年龄范围分别为2.2 - 27 kg和1天至9岁：76%的儿童体重小于10 kg。首次尝试成功率为84%，两次尝试后成功率为100%。该技术还可检测到SCV中的无症状血栓。
这种超声引导的SCV方法为儿童中心静脉置管提供了一种新的可能性。该技术对于体重小于10 kg的儿童似乎很有前景，对年龄较大的儿童可能也有前景。它提供了高质量的针引导，并允许在穿刺前检查血管通畅情况。
