Keidan Ilan, Ben-Menachem Erez, Berger Raanan, Derazne Estella, Berkenstadt Haim
2 Anethesiology, University of Florida, Gainesville, Florida - USA.
J Vasc Access. 2015 May-Jun;16(3):218-22. doi: 10.5301/jva.5000333. Epub 2015 Jan 23.
To determine the feasibility and effectiveness of using a single injection of diluted sodium bicarbonate, while monitoring exhaled carbon dioxide changes, to reliably confirm correct placement of intravenous (IV) catheters.
The study was conducted in the oncology day care clinic at a tertiary care center and included a selected group of patients with various oncological conditions who required IV chemotherapy. In each patient a newly inserted peripheral IV catheter or newly accessed central line was deemed positively intravascular if they had good blood return or most probably intravascular if there was no blood return but they flushed easily. This clinical diagnosis of correct positioning, was correlated with the results of a single injection of dilute sodium on the exhaled carbon dioxide, and with the ability of a blinded observer to report whether sodium bicarbonate or saline was injected.
A total of 67 patients were enrolled in the study; 56 had positively intravascular IV catheter while 11 had most probably intravascular IV catheter. A single injection of 20 mL 4.2% sodium bicarbonate had a positive and clinically detectable response that was diagnosed with high sensitivity and specificity.
IV injection of 20 mL of 4.2% sodium bicarbonate with exhaled carbon dioxide monitoring can be used to reliably confirm correct intravascular placement of a catheter intended to be used for chemotherapy.
在监测呼出二氧化碳变化的同时，确定单次注射稀释碳酸氢钠以可靠确认静脉（IV）导管正确位置的可行性和有效性。
该研究在一家三级护理中心的肿瘤日间护理诊所进行，纳入了一组患有各种肿瘤疾病且需要进行静脉化疗的患者。在每位患者中，如果新插入的外周静脉导管或新接入的中心静脉导管回血良好，则被认为肯定位于血管内；如果没有回血但易于冲洗，则最有可能位于血管内。这种正确定位的临床诊断与单次注射稀释钠后呼出二氧化碳的结果相关，也与一名不知情的观察者报告注射的是碳酸氢钠还是生理盐水的能力相关。
共有67名患者参与了该研究；56名患者的静脉导管肯定位于血管内，11名患者的静脉导管最有可能位于血管内。单次注射20毫升4.2%的碳酸氢钠会产生一种具有高敏感性和特异性的、可在临床上检测到的阳性反应。
静脉注射20毫升4.2%的碳酸氢钠并监测呼出二氧化碳，可用于可靠确认拟用于化疗的导管在血管内的正确位置。
