Napolitano Mariasanta, Malato Alessandra, Raffaele Francesco, Palazzolo Manuela, Lo Iacono Giorgio, Pinna Roberto, Geraci Girolamo, Modica Giuseppe, Saccullo Giorgia, Siragusa Sergio, Cajozzo Massimo
Haematology and Transplant Unit, Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
Blood Transfus. 2013 Oct;11(4):506-9. doi: 10.2450/2013.0129-12. Epub 2013 Jan 23.
Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia.
We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×10(9)/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded.
All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group.
US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion.
颈内静脉置管（CVC）是一种基于体表标志的盲穿技术，对于血小板计数极低的患者可能存在潜在危险。在此类患者中，超声（US）引导下的CVC置管可能是一种有效的方法。目前缺乏关于在严重血小板减少的血液学患者中进行紧急US引导下CVC置管的有效性和安全性的公开数据。
我们回顾性研究了血液学患者紧急CVC置管操作的安全性，包括那些严重血小板减少（血小板计数<30×10⁹/L）的患者。1999年1月至2009年6月，对431例连续患者的431次CVC置管操作进行了评估。如果患者患有血液系统疾病且需要紧急CVC置管，则纳入本研究。患者取头低脚高位，在实时US引导下将18G穿刺针和导丝推进至颈内静脉末端；所有操作均采用Seldinger技术进行颈内静脉中心静脉置管。记录主要和次要的操作相关并发症。
所有431例研究患者均患有血液系统疾病：39例严重血小板减少，对血小板输注无效（第1组），而392例无严重血小板减少（第2组）。两组患者的一般特征仅在血小板计数方面有所不同。操作平均耗时4分钟。第1组和第2组的成功率分别为97.4%和97.9%。两组均未发生严重并发症。
对于需要紧急置管以进行生命支持、血浆置换、化疗和输血的严重血小板减少的血液学患者，US引导下的CVC置管是一种安全有效的方法。
