Breschan C, Platzer M, Likar R
Abt. für Anästhesiologie, Landeskrankenhaus Klagenfurt, St. Veiterstr. 47, 9020, Klagenfurt, Osterreich.
Anaesthesist. 2009 Sep;58(9):897-900, 902-4. doi: 10.1007/s00101-009-1602-4.
In neonates, infants and young children central venous catheters are of vital importance during surgery as well as postoperative care. The benefit of ultrasonography seems to be very important for vascular access of the internal jugular (IJV), subclavian (SCV), femoral and even peripheral veins. Ultrasound-guided cannulation of the IJV increases the success rate, reduces the time to the successful puncture and decreases the inadvertent puncture of the carotid artery in children in comparison to the landmark-guided technique. Due to compression of the vessel by the approaching needle in neonates transfixing the vein and aspirating blood on withdrawal of the needle may be the preferred technique. The lack of space may prevent ultrasound-guided puncture of the SCV in very low birth weight infants. However, the location of the vein and its patency should always be determined via ultrasound prior to cannulation. After catheterization of the SCV the homolateral IJV is screened by the use of ultrasound to detect wrong guide wire migration. A clear and rapid visualization of visceral pleura movement against the parietal pleura during respiration via ultrasound indicates the absence of pneumothorax after cannulation. In the case of haemodynamic instability, ultrasound should be used to exclude pericardial effusion.
在新生儿、婴儿和幼儿中，中心静脉导管在手术及术后护理期间至关重要。超声检查对于颈内静脉（IJV）、锁骨下静脉（SCV）、股静脉乃至外周静脉的血管穿刺似乎非常重要。与体表标志引导技术相比，超声引导下的颈内静脉置管可提高成功率，缩短成功穿刺时间，并减少儿童颈动脉意外穿刺的发生。由于新生儿血管会被进针压迫，在进针时穿透静脉并在退针时回抽血液可能是首选技术。极低出生体重儿可能因空间不足而无法进行超声引导下的锁骨下静脉穿刺。然而，在置管前应始终通过超声确定静脉的位置及其通畅情况。锁骨下静脉置管后，应使用超声检查同侧颈内静脉，以检测导丝误入情况。通过超声清晰快速地观察到呼吸过程中脏层胸膜相对于壁层胸膜的运动，表明置管后无气胸。在血流动力学不稳定的情况下，应使用超声排除心包积液。
