Moayedi Siamak, Witting Michael, Pirotte Matthew
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Emerg Med. 2016 Dec;51(6):636-642. doi: 10.1016/j.jemermed.2016.07.001. Epub 2016 Sep 19.
The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown.
We aimed to estimate efficacy and safety parameters for the Easy IJ when used in emergency department (ED) settings.
We conducted a prospective study of the Easy IJ in stable ED patients with severe intravenous access difficulty. The study was conducted simultaneously at two academic EDs and a community university-affiliated ED. Patients were selected for failure of alternative access, hemodynamic stability, and ability to increase the IJ diameter with the Valsalva maneuver. Emergency physicians prepped the skin and inserted an 18-gauge, 4.8-cm catheter using a limited sterile technique. We collected the following data: patient body mass index, age, procedure time, pain score, initial success, loss of patency, occurrence of pneumothorax, infection, or arterial puncture.
We recorded 83 attempts in 74 patients, with a median age of 44 years and a median body mass index of 27 kg/m. The initial success rate was 88%, with a mean procedure time of 4.4 min (95% confidence interval 3.8-4.9). The average pain score was 3.9 out of 10 (95% confidence interval 3.4-4.5). Ten of 73 successful lines (14%) lost patency. There were no cases of pneumothorax, arterial puncture, or line infection.
The Easy IJ was inserted successfully in 88% of cases, with a mean time of 4.4 min. Loss of patency, the only complication, occurred in 14% of cases.
简易颈内静脉（Easy IJ）技术是指在超声引导下将单腔导管置入颈内静脉。该技术用于外周或颈外静脉通路不适合的患者。此操作的有效性和安全性尚不清楚。
我们旨在评估在急诊科（ED）环境中使用Easy IJ技术时的有效性和安全性参数。
我们对急诊科中静脉通路严重困难的稳定患者进行了一项关于Easy IJ技术的前瞻性研究。该研究在两家学术性急诊科和一家社区大学附属医院急诊科同时进行。入选患者为替代通路失败、血流动力学稳定且能通过瓦尔萨尔瓦动作使颈内静脉直径增加的患者。急诊医生采用有限的无菌技术准备皮肤并插入一根18号、4.8厘米长的导管。我们收集了以下数据：患者体重指数、年龄、操作时间、疼痛评分、首次成功率、通畅性丧失情况、气胸、感染或动脉穿刺的发生情况。
我们记录了74例患者的83次尝试，中位年龄为44岁，中位体重指数为27kg/m²。首次成功率为88%，平均操作时间为4.4分钟（95%置信区间3.8 - 4.9）。平均疼痛评分为10分制中的3.9分（95%置信区间3.4 - 4.5）。73条成功置管中有10条（14%）出现通畅性丧失。未发生气胸、动脉穿刺或导管感染病例。
Easy IJ技术在88%的病例中成功插入，平均时间为4.4分钟。通畅性丧失是唯一的并发症，发生率为14%。
