University of Iowa, Iowa City, IA, USA.
Department of Emergency Medicine, St. Francis Hospital, University of South Carolina School of Medicine, Columbus, GA, USA.
Intensive Care Med. 2019 Apr;45(4):434-446. doi: 10.1007/s00134-019-05564-7. Epub 2019 Feb 18.
Over the past two decades, ultrasound (US) has become widely accepted to guide safe and accurate insertion of vascular devices in critically ill patients. We emphasize central venous catheter insertion, given its broad application in critically ill patients, but also review the use of US for accessing peripheral veins, arteries, the medullary canal, and vessels for institution of extracorporeal life support. To ensure procedural safety and high cannulation success rates we recommend using a systematic protocolized approach for US-guided vascular access in elective clinical situations. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis. This review will address the state of US-guided vascular access, including current practice and future directions.
在过去的二十年中，超声（US）已被广泛接受，用于指导重症患者安全、准确地插入血管装置。我们强调中心静脉导管插入术，因为它在重症患者中有广泛的应用，但也回顾了 US 在使用外周静脉、动脉、骨髓腔和用于建立体外生命支持的血管中的应用。为了确保程序的安全性和高置管成功率，我们建议在择期临床情况下使用系统的、基于协议的方法来进行 US 引导下的血管通路。标准化的方法可最小化临床实践中的变异性，为教育和培训提供框架，促进实施，并实现质量分析。这篇综述将讨论 US 引导下的血管通路的现状，包括当前的实践和未来的方向。
