Hosokawa Koji, Shime Nobuaki, Kato Yuko, Hashimoto Satoru
Department of Anesthesiology, University Hospital, Kyoto Prefectural School of Medicine, Kyoto, Japan.
Anesthesiology. 2007 Nov;107(5):720-4. doi: 10.1097/01.anes.0000287024.19704.96.
Ultrasound-guided central venous catheterization has been recommended to increase the procedural success rate and enhance patient safety. However, few studies have examined the potential advantages of one ultrasound technique with another, specifically in small infants.
The authors randomly assigned 60 neonates and infants weighing less than 7.5 kg to an ultrasound-guided skin-marking method (n = 27) versus real-time ultrasound-assisted internal jugular venous catheterization (n = 33). The times to successful puncture of the internal jugular vein and to catheterization were measured. Attempts at needle punctures for successful catheterization were counted. Procedural complications were recorded.
In the real-time group, compared with the skin- marking group, venous puncture was completed faster (P = 0.03), the time required to catheterize was shorter (P < 0.01), and fewer needle passes were needed. Specifically, fewer than three attempts at puncture were made in 100% of patients in the real-time group, versus 74% of patients in the skin-marking group (P < 0.01). A hematoma and an arterial puncture occurred in one patient each in the skin-marking group.
The real-time ultrasound guidance method could enhance procedural efficacy and safety of internal jugular catheterization in neonates and infants.
超声引导下中心静脉置管术已被推荐用于提高操作成功率并增强患者安全性。然而，很少有研究比较不同超声技术的潜在优势，尤其是在小婴儿中。
作者将60名体重小于7.5kg的新生儿和婴儿随机分为超声引导下皮肤标记法组（n = 27）和实时超声辅助颈内静脉置管组（n = 33）。测量颈内静脉成功穿刺和置管的时间。计算成功置管的穿刺针数。记录操作并发症。
与皮肤标记组相比，实时组静脉穿刺完成更快（P = 0.03），置管所需时间更短（P < 0.01），且穿刺针数更少。具体而言，实时组100%的患者穿刺次数少于3次，而皮肤标记组为74%（P < 0.01）。皮肤标记组各有1例患者发生血肿和动脉穿刺。
实时超声引导方法可提高新生儿和婴儿颈内静脉置管的操作效率和安全性。
