Di Nardo Matteo, Tomasello Caterina, Pittiruti Mauro, Perrotta Daniela, Marano Marco, Cecchetti Corrado, Pasotti Elisabetta, Pirozzi Nicola, Stoppa Francesca
Department of Emergency, Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy.
J Vasc Access. 2011 Oct-Dec;12(4):321-4. doi: 10.5301/JVA.2011.8309.
Recent reports suggest that ultrasound-guided central venous cannulation may also be safe and effective in infants. This study aimed to evaluate the success and complications rate of this technique in infants weighing less than 5 kg.
We studied 45 infants, weighing less than 5 kg (mean weight: 2.9 ± 1.1 kg, median: 3.1) needing a central venous access for intensive care treatment. In all patients, venous access was obtained by ultrasound-guided cannulation of the internal jugular vein (IJV).
Central venous cannulation was successful in all 45 infants. The right internal jugular vein (IJV) was used in most cases (92%). The IJV was antero-lateral to the carotid artery in 66% of patients, lateral in 28% and anterior in 6%. Although we recorded 10 complications (22.2%), only one was clinically relevant (one pneumothorax). The other complications were repeated venipunctures (n=4), kinking of the guidewire (n=3) and local venous hematomas (n=2). The time required for completing the procedure was 7 ± 4.3 min, while the mean time of central venous catheter permanence was 5.5 ± 8 days. There was a negative correlation between the patient's weight and the time needed for cannulation (p<0.01). Complications occurred in infants with a lower body weight (p<0.01).
Our experience suggests that ultrasound-guided central vein cannulation can be performed by well-trained physicians in infants weighing less than 5 kg without relevant risks.
近期报告表明，超声引导下的中心静脉置管术在婴儿中可能也是安全有效的。本研究旨在评估该技术在体重小于5 kg的婴儿中的成功率及并发症发生率。
我们研究了45例体重小于5 kg（平均体重：2.9±1.1 kg，中位数：3.1）、需要进行中心静脉置管以接受重症监护治疗的婴儿。所有患者均通过超声引导下颈内静脉（IJV）置管获得静脉通路。
45例婴儿的中心静脉置管均成功。大多数情况下（92%）使用右侧颈内静脉。66%的患者颈内静脉位于颈动脉前外侧，28%位于外侧，6%位于前方。尽管我们记录了10例并发症（22.2%），但只有1例具有临床相关性（1例气胸）。其他并发症包括重复静脉穿刺（n = 4）、导丝扭结（n = 3）和局部静脉血肿（n = 2）。完成操作所需时间为7±4.3分钟，而中心静脉导管留置的平均时间为5.5±8天。患者体重与置管所需时间呈负相关（p<0.01）。并发症发生在体重较低的婴儿中（p<0.01）。
我们的经验表明，经过良好培训的医生可以在体重小于5 kg的婴儿中进行超声引导下的中心静脉置管，且无相关风险。
