Kim Eun-Hee, Lee Ji-Hyun, Song In-Kyung, Kim Hyun-Chang, Kim Hee-Soo, Kim Jin-Tae
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
Am J Emerg Med. 2016 May;34(5):851-5. doi: 10.1016/j.ajem.2016.01.038. Epub 2016 Feb 12.
The first step for successful ultrasound (US)-guided subclavian vein (SCV) catheterization using a supraclavicular approach is to obtain a good longitudinal image of SCV for in-plane needle placement. We evaluated the efficacy of caudal traction of ipsilateral arm on the exposure of the SCV.
We enrolled 20 infants, 20 children, and 20 adults undergoing general anesthesia. After tracheal intubation, US probe was applied as the supraclavicular approach, and the longitudinal US image of SCV was obtained in 3 different ipsilateral arm positions: neutral, caudal traction, and abduction. The length of puncturable SCV, the diameter of SCV, and the available angle for needle insertion in 3 different arm positions were analyzed.
In all patients, the length of puncturable SCV and the available angle for needle insertion were significantly increased after caudal traction (35.6% ± 27.1% and 25.0% ± 19.3%, respectively) and decreased after the abduction (36.6% ± 22.9% and 29.5% ± 23.8%, respectively) compared to neutral position. The diameter of SCV was not changed after applying the caudal traction in infants and children. However, in adults, the caudal traction slightly increased the diameter of SCV (P = .012).
The caudal traction of ipsilateral arm toward to the knee improves the longitudinal US view of SCV for the supraclavicular approach, without reducing its size. Proper caudal traction of the arm might ensure the high success rate with safe needle insertion technique. Abduction should be avoided during US-guided supraclavicular SCV catheterization.
使用锁骨上入路成功进行超声（US）引导下锁骨下静脉（SCV）置管的第一步是获得良好的SCV纵向图像以进行平面内进针。我们评估了同侧手臂尾侧牵引对SCV暴露的效果。
我们纳入了20例接受全身麻醉的婴儿、20例儿童和20例成人。气管插管后，采用锁骨上入路应用超声探头，在同侧手臂的3种不同位置获得SCV的纵向超声图像：中立位、尾侧牵引位和外展位。分析了3种不同手臂位置下可穿刺SCV的长度、SCV的直径以及进针的可用角度。
在所有患者中，与中立位相比，尾侧牵引后可穿刺SCV的长度和进针的可用角度均显著增加（分别为35.6%±27.1%和25.0%±19.3%），外展位后则减小（分别为36.6%±22.9%和29.5%±23.8%）。婴儿和儿童在进行尾侧牵引后SCV的直径未发生变化。然而，在成人中，尾侧牵引使SCV的直径略有增加（P = 0.012）。
将同侧手臂向膝部进行尾侧牵引可改善锁骨上入路时SCV的纵向超声视野，且不会减小其尺寸。适当的手臂尾侧牵引可能确保安全进针技术的高成功率。在超声引导下锁骨上SCV置管过程中应避免外展。
