Htet Natalie, Vaughn Jessica, Adigopula Sasikanth, Hennessey Erin, Mihm Frederick
Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States.
Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States.
J Crit Care. 2017 Oct;41:194-197. doi: 10.1016/j.jcrc.2017.05.026. Epub 2017 May 25.
Axillary arterial cannulation for blood pressure monitoring has been reported in adults since 1973. Reported failure rates using palpation landmarks are high. This report describes a needle-guided ultrasound technique for axillary arterial line placement in critically ill patients.
A retrospective review of all patients requiring axillary arterial cannulation attempts with ultrasound-assisted needle guidance for hemodynamic monitoring was performed from July 2010 to June 2016 at a single institution.
One hundred fifty nine (159) cannulation attempts were performed in 155 patients. The overall success rate was 97%, with a first pass success rate of 84%. Inexperienced operators performed 49% of procedures under direct faculty supervision, and had a 99% success rate, which was not different from experienced operators. Almost 20% of patients had moderate-to-severe coagulopathy (platelets<50k/uL, INR>2.0 or PTT>60s). Complications reported included the following: nonfunctioning of catheter (6%) and hematoma (6%). Ischemia was noted in 2 patients (1%), but only one was attributed to the arterial catheter.
Use of the needle-guided ultrasound assisted approach for axillary arterial line placement is easily teachable and can be used to promote safe and successful placement of axillary arterial lines for novice learners.
自1973年以来，成人中已报道了用于血压监测的腋动脉插管。据报道，使用触诊标志的失败率很高。本报告描述了一种用于危重病患者腋动脉置管的针引导超声技术。
对2010年7月至2016年6月在单一机构中所有需要在超声辅助针引导下进行腋动脉插管尝试以进行血流动力学监测的患者进行回顾性研究。
对155例患者进行了159次插管尝试。总体成功率为97%，首次穿刺成功率为84%。49%的操作由经验不足的操作者在教员直接监督下进行，成功率为99%，与经验丰富的操作者无差异。近20%的患者患有中度至重度凝血病（血小板<50k/μL，INR>2.0或PTT>60s）。报告的并发症包括：导管无功能（6%）和血肿（6%）。2例患者（1%）出现缺血，但只有1例归因于动脉导管。
针引导超声辅助方法用于腋动脉置管易于传授，可用于促进新手学习者安全、成功地进行腋动脉置管。
