Galante Ori, Slutsky Tzachi, Fuchs Lior, Smoliakov Alexander, Mizrakli Yuval, Novack Victor, Brotfein Evgeni, Klein Moti, Frenkel Amit, Koifman Leonid, Almog Yaniv
1Medical Intensive Care Unit, Soroka University Medical Center; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. 2Department of Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. 3Institute of Diagnostic Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. 4Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. 5Surgical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Crit Care Med. 2017 Oct;45(10):e994-e1000. doi: 10.1097/CCM.0000000000002500.
To evaluate whether a single-operator ultrasound-guided, right-sided, central venous catheter insertion verifies proper placement and shortens time to catheter utilization.
Prospective observational study with historical controls.
Adult ICUs.
Sixty-four consecutive patients undergoing ultrasound-assisted right-sided central venous catheterization compared with 92 serial historic controls who had unassisted central catheter insertion at the same sites.
Subcostal transthoracic echocardiography during catheter insertion.
The primary outcome was the correct placement of the catheter tip determined by postprocedural chest radiography. The subclavian site was used in 41 patients (64%) (inserted without ultrasound guidance) in the ultrasound-assisted group and 62 (67%) in the control group, whereas the jugular vein was used in the remaining patients. The tip was accurately positioned in 59 of 68 patients (86.7%) in the ultrasound-assisted group compared with 51 of 94 (54.8%) in the control group (p < 0.001). The median time from end of the procedure to catheter utilization after chest radiography approval was 2.4 hours.
A single-operator ultrasound-guided central venous catheter insertion is effective in verifying proper tip placement and shortens time to catheter utilization.
评估单人超声引导下右侧中心静脉导管置入术能否确认导管位置正确并缩短导管开始使用的时间。
采用历史对照的前瞻性观察性研究。
成人重症监护病房。
64例连续接受超声辅助右侧中心静脉导管置入术的患者，与92例在相同部位接受非辅助中心静脉导管置入术的历史对照患者进行比较。
导管置入过程中采用肋下经胸超声心动图检查。
主要结局是通过术后胸部X线检查确定导管尖端位置正确。超声辅助组41例患者（64%）（未在超声引导下置入）和对照组62例患者（67%）采用锁骨下途径，其余患者采用颈静脉途径。超声辅助组68例患者中有59例（86.7%）导管尖端位置准确，而对照组94例中有51例（54.8%）（p<0.001）。胸部X线检查批准后，从操作结束到导管开始使用的中位时间为2.4小时。
单人超声引导下中心静脉导管置入术在确认导管尖端位置正确方面有效，并缩短了导管开始使用的时间。
