Martin C, Auffray J P, Albanèse J, Saux P, Gouin F
Ann Fr Anesth Reanim. 1986;5(1):64-6. doi: 10.1016/s0750-7658(86)80124-1.
The choice of venous access can be difficult in patients under intensive care. The axillary vein appeared interesting to evaluate. This prospective study involved 63 punctures carried out in 59 patients during a 16 month period (14 females and 45 males; mean age: 54 +/- 4 yr). 34 patients were tracheostomized and under controlled respiration; some had coagulation abnormalities (8 cases). The other 29 patients were undergoing a preoperative haemodynamic study. Puncture of the axillary vein was carried out with the needle inserted at an angle of 30 degrees to the skin surface and directed parallel to the artery medial to its course. The Seldinger technique was used (catheter and guide wire). Overall success rate was 87.5%. In 73%, less than three attempts were required. After the catheter was set in place in the axillary vein, the mean time required to reach the pulmonary artery was 7 +/- 15 min (range: 20 s-45 min). Less than 1 min was needed in 60%. Extrasystoles were observed in 3.6%. The incidence of arterial puncture was 11% without any late complications. In every case, pulmonary artery and capillary wedge pressure curves were obtained, as well as cardiac output measurements. Mean duration of catheterization was 2 +/- 1.1 days in the preoperative haemodynamic group and 4 +/- 1.7 days in the other. No infectious complication was related to the catheterization. One thrombosis of the axillary and subclavian veins was noted (1.8%). The axillary vein appeared therefore to be useful for pulmonary artery catheterization. It is an alternative choice in patients under controlled ventilation and with coagulation problems.
在重症监护患者中，静脉通路的选择可能会很困难。评估腋静脉似乎很有意义。这项前瞻性研究在16个月期间对59例患者进行了63次穿刺（14名女性和45名男性；平均年龄：54±4岁）。34例患者行气管切开并接受控制呼吸；部分患者有凝血异常（8例）。另外29例患者正在进行术前血流动力学研究。腋静脉穿刺时，将针以与皮肤表面成30度角插入，并平行于动脉内侧的走行方向。采用Seldinger技术（导管和导丝）。总体成功率为87.5%。73%的患者穿刺次数少于三次。将导管置入腋静脉后，到达肺动脉所需的平均时间为7±15分钟（范围：20秒至45分钟）。60%的患者所需时间少于1分钟。观察到3.6%的患者出现早搏。动脉穿刺发生率为11%，无任何晚期并发症。在每种情况下，均获得了肺动脉和毛细血管楔压曲线以及心输出量测量值。术前血流动力学组导管插入的平均持续时间为2±1.1天，另一组为4±1.7天。没有与导管插入相关的感染并发症。记录到1例腋静脉和锁骨下静脉血栓形成（1.8%）。因此，腋静脉似乎可用于肺动脉导管插入术。对于接受控制通气且有凝血问题的患者，它是一种替代选择。
