US Army Institute of Surgical Research, 3400 Rawley E. Chamber Avenue, Fort Sam Houston, San Antonio, TX 78234-6315, USA.
Intensive Care Med. 2013 Jan;39(1):151-4. doi: 10.1007/s00134-012-2751-5. Epub 2012 Nov 17.
Bicaval dual-lumen catheters allow for single-site cannulation venovenous extracorporeal gas exchange and facilitate early mobilization of patients. Using these catheters blood is drained from the superior and inferior venae cavae, pumped through a respiratory membrane, and returned into the right atrium. The insertion of these catheters is challenging as their correct positioning is fundamental to reduce recirculation and avoid severe complications. We describe here a new technique for the positioning of bicaval dual-lumen catheters.
The right internal jugular vein was percutaneously cannulated in nine sheep. The distance between skin and tricuspid valve was measured from the point of pressure change in the waveform of a Swan-Ganz catheter being retracted from the right ventricle into the right atrium. The atrium-tricuspid valve-ventricle axis was determined by observing the fluctuations of the tip of the Swan-Ganz entering the ventricle during fluoroscopy. A bicaval dual-lumen catheter was placed on the basis of these evaluations and connected to an extracorporeal respiratory support system.
The position of the catheter was verified at necropsy approximately 18 h after insertion. In all cases the catheter was correctly placed, with the central port situated in front of the tricuspid valve.
The described technique may help to position bicaval dual-lumen catheters for venovenous extracorporeal gas exchange without the use of transesophageal echocardiography or contrast media during fluoroscopy.
腔静脉双腔导管可实现单部位插管的静脉-静脉体外气体交换，并促进患者的早期活动。使用这些导管，血液从上腔静脉和下腔静脉中抽出，通过呼吸膜泵送，并回流到右心房。这些导管的插入具有挑战性，因为正确的定位对于减少再循环和避免严重并发症至关重要。我们在此描述了一种腔静脉双腔导管定位的新技术。
在 9 只绵羊中经皮穿刺右侧颈内静脉。从 Swan-Ganz 导管从右心室撤回至右心房时波形中的压力变化点测量皮肤与三尖瓣之间的距离。通过观察在透视下 Swan-Ganz 导管尖端进入心室时的波动来确定房室瓣-心室轴。根据这些评估结果放置腔静脉双腔导管，并将其连接到体外呼吸支持系统。
在插入后约 18 小时进行尸检时验证了导管的位置。在所有情况下，导管均正确放置，中央端口位于三尖瓣前方。
该技术可在透视下不使用经食管超声心动图或对比剂的情况下，帮助腔静脉双腔导管定位用于静脉-静脉体外气体交换。
