Gopalasingam Nigopan, Thomsen Anna-Marie Eller, Folkersen Lars, Juhl-Olsen Peter, Sloth Erik
Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus N, 8200, Denmark.
Department of Clinical Immunology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
J Clin Apher. 2017 Dec;32(6):437-443. doi: 10.1002/jca.21533. Epub 2017 Mar 20.
Apheresis treatments can be performed with peripheral venous catheters (PVC), although central venous catheters (CVC) are inserted when PVCs fail or patient with history of difficult vascular access prior to the apheresis. Ultrasound guidance for PVC has shown promising results in other settings.
To investigate if ultrasound guidance for PVC could be implemented among apheresis nurses. Second, how implementation of ultrasound guidance affected the number of CVCs used for apheresis per patient.
Apheresis nurses completed a systematic training program for ultrasound-guided vascular access. All independent catheterizations were registered during the implementation stage. The number of CVCs in the pre- and postimplementation stages of the ultrasound guidance was compared.
Six nurses completed the training program within a median of 48 days (range 38-83 days). In 77 patients, 485 independent ultrasound-guided PVC placements were performed during the implementation stage. All apheresis treatments (485/485) were accomplished using PVCs without requiring CVC as rescue. During the preimplementation stage, 125 of 273 (45.8%) procedures required a CVC for completion of apheresis procedures; during the postimplementation stage only 30 of 227 (13.2%) procedures required a CVC (p < 0.001). In the postimplementation stage, no CVCs were placed as rescue caused by failed PVCs but were only placed for patients where the ultrasound machine was unavailable. It indicates an effective success rate of 100% for ultrasound-guided PVC use.
This study showed that ultrasound guidance could be implemented among apheresis nurses as a routine tool eliminating the need of CVC as a rescue.
虽然当外周静脉导管（PVC）失败或患者在进行血液成分单采前有血管通路困难病史时会插入中心静脉导管（CVC），但血液成分单采治疗也可以通过外周静脉导管来进行。在其他情况下，超声引导下的外周静脉导管置入已显示出良好的效果。
探讨血液成分单采护士是否可以实施超声引导下的外周静脉导管置入。其次，超声引导的实施如何影响每位患者用于血液成分单采的中心静脉导管的使用数量。
血液成分单采护士完成了超声引导下血管通路的系统培训计划。在实施阶段记录所有独立的导管插入操作。比较超声引导实施前后阶段中心静脉导管的使用数量。
6名护士在中位数为48天（范围38 - 83天）内完成了培训计划。在实施阶段，对77例患者进行了485次独立的超声引导下外周静脉导管置入。所有血液成分单采治疗（485/485）均使用外周静脉导管完成，无需中心静脉导管作为补救措施。在实施前阶段，273例操作中有125例（45.8%）需要中心静脉导管来完成血液成分单采操作；在实施后阶段，227例操作中只有30例（13.2%）需要中心静脉导管（p < 0.001）。在实施后阶段，没有因外周静脉导管失败而作为补救措施放置中心静脉导管，仅在超声设备不可用的患者中放置。这表明超声引导下外周静脉导管使用的有效成功率为100%。
本研究表明，超声引导可以作为一种常规工具在血液成分单采护士中实施，从而无需使用中心静脉导管作为补救措施。
