Tripathi Mukesh, Pandey Mamta
Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Paediatr Anaesth. 2008 Nov;18(11):1050-4. doi: 10.1111/j.1460-9592.2008.02776.x.
Internal jugular vein (IJV) cannulation in infants has been reported with varied success using surface landmark. The aim is to share authors experience of modified anchoring technique used in infants.
Anchoring maneuver using pilot needle (PN) has been recently described in adults. We have found that if the PN is left in IJV and then i.v. cannula (22G or 24G) is passed just posterior to the puncture point of PN to track down the PN path at 10-20 degree angles from skin, a natural tumbling movement of the PN helped to anchor anterior wall of IJV and facilitated its puncture. The results of 128 punctures performed in infants (<1 years) were analyzed in two groups of <6 months (n = 52) and >6 months to 1 year (n = 76).
In infants weighing 3.5-14 kg, all cannulations were performed successfully. IJV puncture was detected at the entry of i.v. cannula more often in both the groups (81% in <6 months baby and 84% in >6 months baby) than withdrawing it. In 12 (10%) patients, the puncture site was changed to left IJV as carotid artery was punctured in three and failure to localize right IJV in nine patients by surface landmark.
In authors experience, the described technique detected IJV cannulation at its entry in majority of infants and so the method is less prone to complications related to overshooting of the needle in lack of IJV puncture detection.
据报道，使用体表标志对婴儿进行颈内静脉（IJV）置管的成功率各不相同。目的是分享作者在婴儿中使用改良固定技术的经验。
最近在成人中描述了使用引导针（PN）的固定操作。我们发现，如果将PN留在IJV中，然后将静脉内套管（22G或24G）从PN穿刺点后方穿过，以与皮肤呈10 - 20度角追踪PN路径，PN的自然翻滚运动有助于固定IJV的前壁并便于穿刺。对两组<6个月（n = 52）和>6个月至1岁（n = 76）的婴儿进行的128次穿刺结果进行了分析。
在体重3.5 - 14 kg的婴儿中，所有置管均成功完成。两组中，静脉内套管进入时检测到IJV穿刺的情况比拔出时更常见（<6个月婴儿中为81%，>6个月婴儿中为84%）。在12例（10%）患者中，由于3例穿刺到颈动脉，9例通过体表标志未能定位右侧IJV，穿刺部位改为左侧IJV。
根据作者的经验，所描述的技术在大多数婴儿中于静脉内套管进入时检测到IJV置管，因此该方法不太容易出现因未检测到IJV穿刺而导致的针刺过度相关并发症。
