Docktor B, So C B, Saliken J C, Gray R R
Department of Diagnostic Imaging, University of Calgary Medical School, AB.
Can Assoc Radiol J. 1996 Jun;47(3):195-201.
To examine the effect of variations in anatomic features and operator experience on the success and complication rates of sonographically monitored cannulation of the internal jugular vein.
The authors prospectively collected data for ultrasound-monitored cannulation of the internal jugular vein in 150 patients. In all cases the radiologist recorded the side of puncture, the number of passes needed, the number of vein punctures (one or two), whether the walls were opposed during puncture and any complications. For the last 80 patients the following information was also recorded: the distance from the skin to the internal jugular vein, the diameter of the vein with the Valsalva manoeuvre and the location of the vein relative to the carotid artery. All but three of the cannulations were performed by one of three radiologists, all of whom had at least 5 years of experience.
Cannulation was successful in all of the patients, and the first pass was successful in 133 (88.7%). These results are better than those of blind placement techniques reported in the literature. The only complications were hematoma and carotid puncture, which both occurred in the same two patients (1.3%). There was no significant difference among the radiologists in the number of passes needed (one-way analysis of variance, p > 0.05). The number of passes was independent of anatomic factors, including depth from skin, vein diameter or relative location. However, significantly more passes were needed for left-side punctures than for right-side punctures (Student t-test, p < 0.05).
Real-time ultrasound monitoring is superior to blind techniques in cannulation of the internal jugular vein because of its ease, accuracy and safety. Sonographic real-time monitoring minimizes the impact of anatomic factors on success and complication rates. It is a safe and efficacious approach that should be preferred in the placement of central lines.
探讨解剖结构差异及操作者经验对超声引导下颈内静脉置管成功率及并发症发生率的影响。
作者前瞻性收集了150例患者超声引导下颈内静脉置管的数据。在所有病例中，放射科医生记录穿刺侧、所需穿刺次数、静脉穿刺次数（一次或两次）、穿刺时血管壁是否对合以及任何并发症。对于最后80例患者，还记录了以下信息：皮肤至颈内静脉的距离、行瓦尔萨尔瓦动作时静脉的直径以及静脉相对于颈动脉的位置。除3例置管外，其余均由三位放射科医生之一完成，他们均有至少5年的经验。
所有患者置管均成功，首次穿刺成功133例（88.7%）。这些结果优于文献报道的盲目置管技术。仅有的并发症是血肿和颈动脉穿刺，均发生在同一两名患者中（1.3%）。放射科医生之间所需穿刺次数无显著差异（单因素方差分析，p>0.05）。穿刺次数与解剖因素无关，包括皮肤深度、静脉直径或相对位置。然而，左侧穿刺所需穿刺次数明显多于右侧穿刺（学生t检验，p<0.05）。
实时超声监测在颈内静脉置管方面优于盲目技术，因其操作简便、准确且安全。超声实时监测可将解剖因素对成功率和并发症发生率的影响降至最低。这是一种安全有效的方法，在中心静脉置管时应优先选用。
