Department of Emergency Medicine, Monash Medical Centre, Melbourne, Victoria, Australia.
Emerg Med Australas. 2010 Apr;22(2):166-70. doi: 10.1111/j.1742-6723.2010.01281.x.
To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED.
A prospective, observational study of a convenience sample comparing the landmark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007. Clinicians involved under went 3 months of training in US physics and with practical models. Clinicians estimated the degree of difficulty of insertion (using a Likert scale) before each line placement. Data including time of procedure and success or failure were collected, using a standardized clinical record form, by an observing researcher.
A total of 84 patients were enrolled. There were 61 line placement episodes in the landmark group (with 253 attempts), and 38 in the US group (with 90 attempts). US recorded slightly higher success per attempt overall (42% vs 38%, P=0.08), and performed better in the patients with difficult access (success 35% vs 18%, P=0.003). US attempts took longer than landmark attempts (2 min 15 s vs 4 min, P<0.001).
The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access.
评估美国在小儿急诊外周静脉通路中的应用及其实用性。
这是一项前瞻性、观察性研究，对 2006 年 7 月至 2007 年 2 月的便利样本进行比较，比较了地标和超声引导技术在小儿外周血管通路中的应用。参与的临床医生接受了 3 个月的超声物理和实际模型培训。在每次置管前，临床医生使用李克特量表评估置管的难度程度。通过一名观察研究员，使用标准化临床记录表格收集包括手术时间和成败在内的数据。
共纳入 84 例患者。地标组有 61 次置管（253 次尝试），超声组有 38 次（90 次尝试）。总体而言，超声记录的每次尝试成功率略高（42%比 38%，P=0.08），在难度较大的患者中表现更好（成功率 35%比 18%，P=0.003）。超声尝试时间长于地标尝试（2 分 15 秒比 4 分钟，P<0.001）。
对于血管通路评估为困难或非常困难的儿童，超声引导可能会提高外周血管通路的成功率。
