Kim Sun Key, Ahn Jung Hwan, Lee Yoon Kyung, Hwang Bo Young, Lee Min Kyung, Kim Il Seok
Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea.
Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Korea.
J Clin Med. 2022 Jun 27;11(13):3692. doi: 10.3390/jcm11133692.
Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.
基于导管路径和导管尖端位置，左锁骨下静脉置管会增加血管损伤和血栓形成的风险。我们使用经食管超声心动图研究了使用传统体表标志进行尖端定位的准确性。选择气管隆突作为放射学标志，右第三肋间作为解剖标志，将尖端定位在目标区域内，目标区域定义为右心房交界处上方2 cm和下方1 cm范围内。总共120名参与者被随机分为两组。放射学组通过右第一肋间将导管插入深度确定为比静脉插入点与气管隆突之间的距离多1.5 cm，解剖学组通过右第一肋间将导管插入深度确定为比静脉插入点与右第三肋间之间的距离。放射学组和解剖学组确定的插入深度与右心房交界处的实际距离分别为19.5 cm和20.5 cm，以及19.8 cm和20.4 cm。解剖学组可接受定位的频率更高（96.4%对85.7%；P = 0.047）。与放射学标志相比，使用解剖学标志时导管尖端在远端上腔静脉中的定位更准确。
