Vezzani A, Manca T, Vercelli A, Braghieri A, Magnacavallo A
Terapia Intensiva Cardiochirurgica, Dipartimento Cardio Nefro Polmonare, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy.
U.O.C. di Pronto Soccorso/OBI/Medicina D'Urgenza, Ospedale G. Da Saliceto, 29100 Piacenza, Italy.
J Ultrasound. 2013 Oct 29;16(4):161-70. doi: 10.1007/s40477-013-0046-5.
Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures.
用于治疗患者的血管通路包括中心静脉通路、外周静脉通路和动脉通路。中心静脉置管在临床实践中广泛应用；它是各种情况下患者治疗的必要组成部分。最常涉及的血管是颈内静脉、锁骨下静脉和股静脉。当在实时超声引导下或（程度稍低）超声辅助下进行中心静脉置管操作时，其机械、感染和血栓形成并发症会显著减少。超声引导还用于建立外周静脉通路、外周静脉置管以及中心静脉导管的外周置入。在这种情况下，它可提高置管成功率，尤其是在困难操作（如肥胖患者、儿童）期间，并减少诸如导管相关感染和静脉血栓形成等并发症。动脉插管用于动脉压的有创监测以及诊断或治疗操作期间的通路建立。超声引导可降低置管失败和并发症的风险。它对于在无法触及脉搏的情况下进行的动脉置管操作（如休克患者、体外膜肺氧合患者）尤其有用。成像支持越来越多地用于在困难条件下协助建立血管通路，部分原因是超声检查作为床边操作的使用日益增加。在因高龄和/或复杂疾病而使患者越来越脆弱的临床环境中，降低这些侵入性操作相关风险的可能性应促使临床医生掌握在血管通路操作期间常规使用超声支持所需的技术技能。
