Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Intensive Care Med. 2020 Mar;35(3):303-321. doi: 10.1177/0885066619868164. Epub 2019 Aug 6.
Ultrasound-guided central line placement has been shown to decrease the number of needle puncture attempts, complication, and failure rates. In order to obtain successful central access, it is important to have adequate cognitive knowledge, workflow understanding, and manual dexterity to safely execute this invasive procedure. The operator should also be familiar with the anatomical variations, equipment operations, and potential complications and their prevention. In this article, we present a detailed review of ultrasound-guided central venous access. It includes a description of anatomy, operative technique, equipment operation, and techniques for specific situations. We describe the use of ultrasound guidance to avoid and identify various complications associated with this procedure. We have also reviewed recent recommendations and guidelines for the use of ultrasound for central venous access and the current evidence pertaining to the recommendations for the expected level of training, methodology, and metrics for establishing competency.
超声引导下的中心静脉置管术已被证明可以减少穿刺次数、并发症和失败率。为了获得成功的中心通路，重要的是要有足够的认知知识、工作流程理解和手动灵巧性，以安全地执行这种有创程序。操作人员还应熟悉解剖变异、设备操作以及潜在的并发症及其预防措施。在本文中，我们对超声引导下的中心静脉通路进行了详细的回顾。它包括对解剖结构、手术技术、设备操作以及特定情况下的技术的描述。我们描述了使用超声引导来避免和识别与该程序相关的各种并发症。我们还回顾了最近关于超声在中心静脉置管中的应用的建议和指南，以及与建立能力的预期培训水平、方法和指标相关的当前证据。
