Belani K G, Buckley J J, Gordon J R, Castaneda W
Anesth Analg. 1980 Jan;59(1):40-4.
To compare the rate of success and incidence of complications associated with two currently popular routes of percutaneous central venous cannulation, we studied 167 patient in whom either internal or external jugular vein catheterization was attempted. Internal jugular vein (IJV) catheterization (125 patients) was successful in 91%; an intrathoracic location was achieved in 100%; complications occurred in 12.8%. Complications included one case of catheter malposition, one case of tension pneumothorax, and 12 instances of inadvertent carotid artery puncture, one resulting in a paratracheal hematoma and phrenic nerve compression. The success rate of IJV cannulation was higher and carotid artery puncture less frequent when an 18-gauge thin-walled needle and a straight guide-wire were used than when IJV cannulation was performed by bind puncture with a larger over-the-needle catheter. Delayed vein perforation occurred twice. External jugular vein cannulation (42 patients), using a "J" wire technique, yielded a 76% success rate: 93.7% of catheter tips reached an intrathoracic location. No complications occurred. We conclude that IJV cannulation is a more reliable means of percutaneous central venous line placement but is associated with a significant incidence of complications which can be reduced if a technique employing a scout needle and guide-wire is used.
为比较两种当前常用的经皮中心静脉置管途径的成功率及并发症发生率，我们对167例尝试进行颈内静脉或颈外静脉置管的患者进行了研究。颈内静脉（IJV）置管（125例患者）成功率为91%；导管尖端位于胸腔内的成功率为100%；并发症发生率为12.8%。并发症包括1例导管位置不当、1例张力性气胸以及12例意外颈动脉穿刺，其中1例导致气管旁血肿和膈神经受压。与使用较大的穿刺针导管盲穿进行颈内静脉置管相比，使用18号薄壁穿刺针和直导丝进行颈内静脉置管时，成功率更高，颈动脉穿刺的发生率更低。延迟性静脉穿孔发生了2次。采用“J”形导丝技术进行颈外静脉置管（42例患者），成功率为76%：93.7%的导管尖端位于胸腔内。未发生并发症。我们得出结论，颈内静脉置管是一种更可靠的经皮中心静脉置管方法，但并发症发生率较高，如果采用使用引导针和导丝的技术，并发症发生率可以降低。
