静脉穿刺时瓦氏动作与使用止血带的比较。

The Valsalva manoeuvre versus tourniquet for venipuncture.

作者信息

Villa Gianluca, Chelazzi Cosimo, Giua Rosa, Lavacchini Laura, Tofani Lorenzo, Zagli Giovanni, Barbani Francesco, De Gaudio A Raffaele, Romagnoli Stefano, Pinelli Fulvio

机构信息

1 Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Florence, Italy.

2 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

出版信息

J Vasc Access. 2018 Sep;19(5):436-440. doi: 10.1177/1129729818757977. Epub 2018 Mar 22.

DOI:10.1177/1129729818757977

PMID:29562836

Abstract

BACKGROUND

During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short- and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm.

METHOD

Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement.

RESULTS

The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = -inf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = -0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01).

DISCUSSION

This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet.

摘要

背景

在超声引导下进行插管时，静脉穿刺需要静脉充盈。在腋窝处使用带有弹性管的止血带是诱导手臂深静脉插管时静脉淤滞的最常用方法。尽管这种方法有效，但可能会伴有短期和长期并发症。瓦尔萨尔瓦动作已被用于使其他胸外静脉产生静脉充盈。这项观察性研究的目的是证明在超声引导下进行手臂深静脉插管时，瓦尔萨尔瓦动作相对于弹性止血带对静脉扩张的影响。

方法

前瞻性观察69例计划进行贵要静脉或肱静脉插管的患者。记录静息时以及进行瓦尔萨尔瓦动作或放置止血带10秒后的静脉直径。

结果

止血带和瓦尔萨尔瓦动作期间贵要静脉直径的平均差异为0.006毫米（95%置信区间=-∞，0.09），标准差为0.5毫米（95%置信区间=0.5，0.7；p>0.01）。止血带和瓦尔萨尔瓦动作期间肱静脉直径的平均差异为0.04毫米（95%置信区间=-0.23，0.15），标准差为0.8毫米（95%置信区间=0.7，0.9；p>0.01）。