兰州大学学报(医学版)2024,Vol.50Issue(9) :40-46.DOI:10.13885/j.issn.1000-2812.2024.09.007

穿刺针预装载导丝技术在小儿超声引导下头臂静脉导管插入术中的应用

Application of needle preloaded with guide-wire technology in pediatric ultrasound-guided brachiocephalic vein catheterization

贾海涛 刘鹏 马翔宇 张伟 何云清 周佼佼 王文晖 周文宇 黄生辉
兰州大学学报(医学版)2024,Vol.50Issue(9) :40-46.DOI:10.13885/j.issn.1000-2812.2024.09.007

穿刺针预装载导丝技术在小儿超声引导下头臂静脉导管插入术中的应用

Application of needle preloaded with guide-wire technology in pediatric ultrasound-guided brachiocephalic vein catheterization

贾海涛 1刘鹏 2马翔宇 2张伟 1何云清 2周佼佼 2王文晖 2周文宇 2黄生辉1
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作者信息

  • 1. 兰州大学第二医院 麻醉手术科,甘肃 兰州 730030;兰州大学 第二临床医学院,甘肃 兰州 730030
  • 2. 兰州大学 第二临床医学院,甘肃 兰州 730030
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摘要

目的 评估穿刺针预装载导丝技术在小儿患者锁骨上路径超声引导头臂静脉(BCV)中心静脉导管插入术(CVC)中的有效性和安全性.方法 穿刺前将穿刺针和装有导丝的塑料鞘相连,并将导丝推进至穿刺针的尖端.超声探头置于锁骨上窝,使用长轴平面内引导技术由探头的外侧向内侧进行BCV穿刺和导丝置入.评估左右侧BCV血管穿刺、导丝置入、导管放置成功率及并发症.结果 共纳入60例患儿,平均年龄135 d(4~330 d),平均体重5.8 kg(2.8~8.9 kg).所有患儿均在3次内成功完成BCV穿刺,首次穿刺成功率为70%.导丝置入次数均≤3次,首次导丝置入成功率为92%.导管置入次数均≤2次,首次导管置入成功率为92%.CVC成功率为100%.4例(7%)患儿在BCV穿刺过程中出现皮下血肿.血管穿刺、导丝置入、导管放置成功率在左侧和右侧BCV间无统计学意义(P>0.05).结论 穿刺针预装载导丝技术可安全有效地用于小儿患者锁骨上路径超声引导BCV穿刺置管术.左侧或右侧BCV的选择可基于临床环境和操作者的经验.

Abstract

Objective To evaluate the efficacy and safety of needle preloaded with a guide-wire for ultrasound-guided catheterization of brachiocephalic vein(BCV)in pediatric patients.Methods The needle was attached to the plastic cover of the guide-wire prior to skin puncture,and the guide-wire was then advanced near the tip of the needle.The probe was placed in the supraclavicular fossa,and then BCV puncture and guide-wire advancement was strictly under the long axis in-plane ultrasound-guided from lateral to medial of the probe.Success rates of vascular puncture,guide-wire and catheter placement,as well as immediate complications,were assessed.Results A total of 60 infant patients were included in this prospective observational study.The mean±standard deviation(SD)of age and weight was 135 days(range 4~330 days)and 5.8 kg(2.8~8.9 kg),respectively.All puncture attempts were≤3;the success rate on the first attempt was 70%.The guide-wire attempts were also≤3;the successful insertion on the first attempt was 92%.The catheter placement attempts were≤2;the successful placement on the first attempt was 92%and the overall success rate of CVC was 100%.Four patients(7%)had subcutaneous hematoma during venipuncture.There were no significant differ-ences between left and right BCV in the success rates of vascular puncture,guide-wire and catheter placement(P>0.05).Conclusion The needle preloaded with a guide-wire can be used safely and effectively in supra-clavicular ultrasound-guided BCV catheterization in pediatric patients.The choice of left or right BCV may depend on each clinical context and operator experience.

关键词

超声引导/穿刺针/导丝/头臂静脉/小儿/中心静脉导管插入术

Key words

ultrasound-guided/needle/guide-wire/brachiocephalic vein/pediatric/central venous catheter-ization

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基金项目

兰州大学第二医院"萃英学子科研培育"计划资助项目(CYXZ2022-52)

出版年

2024
兰州大学学报(医学版)
兰州大学

兰州大学学报(医学版)

CSTPCD
影响因子:0.641
ISSN:1000-2812
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