Cavatorta F, Zollo A, Galli S, Dolla D
Department of Nephrology and Dialysis, General Hospital, Imperia - Italy.
J Vasc Access. 2001 Apr-Jun;2(2):40-4. doi: 10.1177/112972980100200203.
The authors report on their experience with internal jugular vein catheterization with temporary and tunnelled cuffed hemodialysis catheters in 527 patients from 1991 to 2001, using ultrasound guidance and monitoring of catheter placement by endocavitary electrocardiography. The incidence of successful puncture and cannulation using ultrasound was 99.62%. The majority of patients had catheters inserted on the first pass (93%) and fewer attempts were required (range, 2 to 5). In the first year of the procedure in 1991, we observed two cases of accidental puncture of the carotid artery because of an error in ultrasound localization of the neck vessel. Arrhythmias were not observed during this procedure. Right atrial electrocardiography was successful on 504 occasions (96.83%), and correct catheter placement was confirmed by plain chest-X-ray in the first 100 patients. The results confirm that real-time ultrasound guidance for catheter insertion is superior to tradi-tional techniques relying on anatomic landmarks and should be adopted as the standard of care. Ultrasound guidance and EC-ECG improves both the success and the safety of internal jugular catheter insertion. The authors propose that EC-ECG be validated as a technique in compliance with recent Food and Drug Ad-ministration guidelines regarding the location of central venous catheter tips.
作者报告了他们在1991年至2001年期间，对527例患者使用超声引导并通过腔内心电图监测导管位置，进行颈内静脉临时和带隧道带 cuff 血液透析导管置管的经验。使用超声进行成功穿刺和置管的发生率为99.62%。大多数患者在首次穿刺时就成功置入导管（93%），所需尝试次数较少（范围为2至5次）。在1991年开展该操作的第一年，我们观察到2例因颈部血管超声定位错误导致的颈动脉意外穿刺。在此操作过程中未观察到心律失常。右房心电图成功记录504次（96.83%），在前100例患者中通过胸部X线平片确认了导管位置正确。结果证实，实时超声引导下的导管插入术优于依赖解剖标志的传统技术，应作为标准治疗方法采用。超声引导和腔内心电图监测提高了颈内静脉导管插入的成功率和安全性。作者建议，腔内心电图监测应作为一种符合美国食品药品监督管理局关于中心静脉导管尖端位置最新指南的技术进行验证。
