1Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. 2Pediatric Cardiac Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. 3Emergency Care, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Rome, Italy.
Pediatr Crit Care Med. 2014 Feb;15(2):e44-8. doi: 10.1097/01.pcc.0000436200.00089.fb.
To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions.
Retrospective cohort.
PICU of a tertiary pediatric hospital.
Thirty-four patients requiring central venous catheterization from January 2011 to January 2012.
None.
Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days.
Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.
评估超声引导下左侧头臂静脉置管术在伴有潜在出血性疾病的婴儿和儿童中的安全性和有效性。
回顾性队列研究。
一家三级儿科医院的 PICU。
2011 年 1 月至 2012 年 1 月期间需要中心静脉置管的 34 名患者。
无。
两名具有超声引导血管置管经验的儿科重症监护医师进行了左侧头臂静脉的超声置管。超声设备由带有线性 6-13 MHz 探头的标准超声监护仪组成。超声监护仪的分辨率设置为婴儿 1.8 厘米，儿童 2.2 厘米。所有患者均采用“平面内”技术。共进行了 34 次置管。患者的中位年龄为 12.5 个月（5.75-63.5 个月），中位体重为 9.25 公斤（7-16.25 公斤）。分析的婴儿和儿童人群由 25 例接受造血干细胞移植治疗的血液系统疾病患者（73%）、5 例因病毒性肺炎接受体外膜氧合支持的患者（15%）和 4 例患有尿毒症性溶血性综合征的患者（12%）组成。79%的病例使用了 4F 导管。34 例患者均成功进行了左侧头臂静脉置管。置管所需的中位时间为 350 秒（277.5-450 秒）。总的并发症发生率为 9%（34 例中有 3 例），包括静脉穿刺后导丝推进困难。导管定位和并发症所需的时间与患者的体重和体表面积均无相关性（p > 0.05）。中心静脉导管的平均使用时间为 32 ± 4 天。
本回顾性研究的数据证实了超声引导下左侧头臂静脉置管术在伴有潜在出血性疾病的婴儿和儿童中的安全性和有效性。
