Department of Anesthesiology, University of Colorado, Aurora, CO 80045, USA.
J Neurosurg Anesthesiol. 2013 Jan;25(1):62-5. doi: 10.1097/ANA.0b013e318264542e.
Controversy exists regarding the increased safety profile when ultrasound is used for central venous catheters inserted in the subclavian or axillary vein. The critically ill neurosurgical patient presents unique considerations for the optimal central line approach.
This report is a retrospective chart review of 6 neurosurgical intensive care patients in whom an ultrasound-guided, transpectoral, axillary vein catheterization was attempted. A sterile technique was observed. The anatomy was confirmed using combined transverse, longitudinal, and Doppler flow images. The needle tip was advanced into the axillary vein under real-time ultrasound using an in-plane technique. The central venous catheter was inserted using the Seldinger technique. A chest radiograph was obtained after each line.
Five of the 6 central lines were inserted easily, without complications. The sixth central line was inserted without complications but more proximally because of difficulty in visualizing the axillary vein on account of the patient's morbid obesity and severe hypovolemia.
This series illustrates new and useful aspects of ultrasound use in transpectoral axillary vein catheterization: it requires minimal additional training; it combines the real time, in-plane technique with transverse, longitudinal, and Doppler color flow images; and it is used safely in the critically ill neurosurgical patient. The data on infraclavicular central venous catheters indicate decreased line sepsis, arterial punctures, and venous thrombosis while improving nursing care and patient comfort. This technique's potential for decreasing the risk of pneumothorax may make it a reasonable option for many critically ill patients in whom other central venous catheter approaches may not be ideal.
在超声引导下进行锁骨下或腋静脉中心静脉置管时，安全性增加的问题存在争议。重症神经外科患者的最佳中心静脉通路有其独特的考虑因素。
这是一项对 6 例神经外科重症监护患者的回顾性图表研究，他们尝试进行超声引导的经胸腋静脉置管。观察无菌技术。使用横向、纵向和多普勒血流图像组合确认解剖结构。在实时超声下，采用平面内技术将针尖推进腋静脉。使用 Seldinger 技术插入中心静脉导管。每条线后均获得胸部 X 线片。
6 条中心静脉置管中有 5 条顺利插入，无并发症。第 6 条中心静脉置管无并发症，但由于患者病态肥胖和严重低血容量导致腋静脉难以可视化，因此插入位置更靠近近端。
本系列说明了经胸腋静脉置管中超声应用的新的和有用的方面：它需要最少的额外培训；它将实时平面内技术与横向、纵向和多普勒彩色血流图像相结合；并且在重症神经外科患者中安全使用。锁骨下中心静脉导管的数据表明，感染率、动脉穿刺和静脉血栓形成减少，同时改善了护理和患者舒适度。这种技术降低气胸风险的潜力可能使其成为许多其他中心静脉通路不理想的重症患者的合理选择。
