Kim Se-Chan, Klebach Christian, Heinze Ingo, Hoeft Andreas, Baumgarten Georg, Weber Stefan
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn;
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn.
J Vis Exp. 2014 Dec 23(94):52160. doi: 10.3791/52160.
The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.
锁骨上窝超声视图可用于中心静脉导管（CVC）置入。使用微凸超声探头对颈内静脉（IJV）或锁骨下静脉进行静脉穿刺，采用新生儿腹部预设模式，探头频率为10兆赫，深度为10 - 12厘米。将导丝插入静脉后，将探头移至右锁骨上窝以获取上腔静脉（SVC）、右肺动脉和升主动脉的视图。在实时超声视图下，可视化导丝及其J形尖端并向前推送至下腔静脉。使用中心静脉导管从导丝标记处读取插入深度。然后在皮肤和静脉扩张后插入CVC。锁骨上窝视图最适合右颈内静脉CVC插入。如果选择其他插入部位，右锁骨上窝应在无菌区内。在静脉穿刺前，对颈内静脉、头臂静脉和上腔静脉进行扫描可发现明显血栓形成。在实时超声引导下，可通过导丝更换技术纠正误置的CVC。结合诊断性肺部超声扫描，该技术有可能取代胸部X线片来确认CVC尖端位置并排除气胸。此外，对于非P波心律的患者，该视图具有优势，因为此时进行心内心电图（ECG）以确认CVC尖端位置不可行。该方法的局限性在于缺乏微凸探头以及需要培训。
