Srinivasan Shrikanth, Govil Deepak, Gupta Sachin, Patel Sweta, Jagadeesh K N, Tomar Deeksha Singh
Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
Indian J Anaesth. 2017 Mar;61(3):240-244. doi: 10.4103/ija.IJA_632_16.
The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique.
One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded.
Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B.
Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation.
颈内静脉（IJV）置管过程中后壁穿透（贯通穿刺）的真实发生率尚不清楚。如果形成血肿、穿透和/或意外穿刺到下方的颈动脉，可能会产生影响。本研究比较了超声引导下与传统体表标志引导技术在颈内静脉置管时后壁穿刺的发生率。
170例入住胃肠肝病重症监护病房且需要中心静脉置管的成年患者被随机分为A组：采用解剖标志引导技术进行颈内静脉置管；B组：采用实时超声引导进行颈内静脉置管。两组均由另一名研究人员使用实时超声跟踪针的路径。记录后壁穿刺的发生率、成功置管的尝试次数、意外动脉穿刺的发生率以及血肿形成和气胸等并发症的发生情况。
A组有37/80（46%）的患者发生后壁穿刺，显著高于B组的19/90（21%）。A组动脉穿刺发生率为8/80（10%），B组为5/90（5.5%）。B组静脉置管尝试次数和血肿形成发生率显著更低。
实时超声引导下的颈内静脉置管显著降低但并未完全消除后壁静脉穿透的发生率。它还显著降低了意外动脉穿刺的发生率和成功置管的尝试次数。
