Yuan Fang, Liu Yinghong, Li Zheng, Zhu Jianling, Cao Danming, Li Yining
Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014 Jan;39(1):61-6. doi: 10.11817/j.issn.1672-7347.2014.01.011.
To investigate the value of real-time ultrasound guided placement of permanent internal jugular vein (IJV) catheterization in maintenance hemodialysis patients, and analyze its technical success and complication rate.
We prospectively analyzed 63 patients (39 males, 24 females) who underwent permanent IJV cannulation with real-time ultrasound guidance from January to October in 2012. Under the real-time guidance of Logiq 5 color Doppler, we placed the tunneled cuffed catheters into the jugular vein by Seldinger technique. The number of needle punctures, technical success, the operation time, and complications were recorded. The patients were divided into a normal-risk group and a high-risk group: those who suffered multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk patients.
Cannulation of IJV was done in all patients. Of the 63 catheters, 20 (31.7%) were placed in the high-risk patients; 60 (95.2%) were successfully placed at the first attempt, with the average number of punctures of (1.23±0.21) (range 1-3); Only 3 immediate complications (4.7%) developed; 3 (4.7%) catheter infections occurred in the course of using. Cannulation of IJV took longer time in the high-risk group than that in the normal-risk group [(30.6±0.11) min vs (19.1±0.09) min, P<0.05]. The number of needle punctures, percent of successful cannulation, and the frequency of immediate complications were similar in the high- and normal-risk groups. It was more likely to form catheter thrombosis during long-term use in the high-risk group (4/20, 20%) which might cause poor blood flow.
Permanent IJV cannulation under real-time ultrasound guidance is very safe with high success rates. Nephrologists can use this technique with ease and with minimal complications in both normal- and high-risk patients.
探讨实时超声引导下永久性颈内静脉（IJV）置管在维持性血液透析患者中的应用价值，并分析其技术成功率及并发症发生率。
对2012年1月至10月间63例行实时超声引导下永久性IJV置管的患者（男性39例，女性24例）进行前瞻性分析。在Logiq 5彩色多普勒实时引导下，采用Seldinger技术将带隧道涤纶套导管置入颈静脉。记录穿刺针数、技术成功率、手术时间及并发症情况。将患者分为正常风险组和高风险组：曾多次置管、既往置管困难、依从性差、肥胖、意识障碍、骨骼畸形、凝血功能障碍者视为高风险患者。
所有患者均成功完成IJV置管。63根导管中，20根（31.7%）置管于高风险患者；60根（95.2%）首次穿刺成功，平均穿刺次数为（1.23±0.21）次（范围1 - 3次）；仅发生3例（4.7%）即刻并发症；使用过程中发生3例（4.7%）导管感染。高风险组IJV置管时间长于正常风险组[（30.6±0.11）分钟 vs （19.1±0.09）分钟，P<0.05]。高风险组与正常风险组的穿刺针数、置管成功率及即刻并发症发生率相似。高风险组长期使用时更易形成导管血栓（4/20，20%），可能导致血流量不佳。
实时超声引导下永久性IJV置管非常安全，成功率高。肾内科医生可在正常风险和高风险患者中轻松使用该技术，且并发症极少。
