Al Sofyani Khouloud, Julia Guilbert, Abdulaziz Boker, Yves Chevalier Jean, Sylvain Renolleau
Department of Pediatric and Neonatal Intensive Care Unit, Armand Trousseau Hospital, APHP, UMPC Paris VI, Paris, France.
Saudi J Anaesth. 2012 Apr;6(2):120-4. doi: 10.4103/1658-354X.97023.
Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group.
After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204) months and weight 9.3 (1.9-60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics(®) Burroughs, USA) covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications.
Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique.
In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal and pediatric patients.
婴幼儿经皮中心静脉置管（CVC）是一项具有挑战性的操作，通常采用盲视、外部体表标志引导技术来完成。英国国家卫生与临床优化研究所（NICE）近期发布的指南推荐在儿童中心静脉置管时使用超声引导。本研究旨在评估该方法在儿科和新生儿重症监护病房中的应用情况，评估穿刺尝试次数、进针时间（从皮肤到静脉）、并发症发生率以及新生儿年龄组中心静脉置管的易用性。
经当地部门伦理委员会批准后，我们在6个月的时间里，对儿科重症监护病房和新生儿重症监护病房中20例需要中心静脉置管的危重症患者（中位年龄9（0 - 204）个月，体重9.3（1.9 - 60）kg）评估了一种超声引导方法。在使用无菌护套覆盖的超声设备（8 MHz探头，美国通用电气公司（®）Vividi Burroughs）定位穿刺部位后进行置管。观察指标包括置管成功率、穿刺尝试次数、进针时间和并发症发生率。
所有患者中心静脉置管成功率均为100%。60%的病例首选右股静脉。75%的患者首次尝试即成功进入静脉，中位穿刺尝试次数为1次。所有患者的中位进针时间（从皮肤到静脉）为64.5秒。使用超声技术未发生动脉穿刺或血肿。
在儿科和新生儿重症监护病房的危重症患者样本中，与传统技术的已发表报告相比，超声引导下的CVC穿刺尝试次数更少、时间更短。它提高了总体成功率，将静脉置管期间并发症的发生率降至最低，并且易于应用于新生儿和儿科患者。
