中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (09): 787-789.

• 论著 • 上一篇    下一篇

生理盐水冲击法床旁检测锁骨下静脉导管误入颈内静脉

马晋平，吴恺明，蔡世荣，陈创奇，崔    冀，吴    晖，彭建军，韩方海，何裕隆，詹文华   

  1. 中山大学附属第一医院胃肠胰腺外科 中山大学胃癌诊治研究中心，广东广州 510080
  • 出版日期:2010-09-01 发布日期:2010-09-01

  • Online:2010-09-01 Published:2010-09-01

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摘要：

目的    研究床旁简单实用检测锁骨下静脉插管误入同侧颈内静脉的方法。方法    自2008年1月至2010年3月期间中山大学附属第一医院胃肠胰腺外科对179例胃肠癌病人实施右侧锁骨下静脉穿刺置管。置管成功后,向导管内快速推注10mL生理盐水，同时触诊病人同侧颈内静脉处，手掌有震颤感为阳性。所有病人置管后均行胸部计算机X线摄影（CR）。 结果    剔除7例穿刺失败病例。9例（5.23%）阳性,均经胸部CR证实为导管误入同侧颈内静脉。未发现假阳性和假阴性病例。胸部CR发现另有3例（1.74%）病人的导管经胸部CR证实插入右心房。结论    生理盐水冲击法是检测锁骨下静脉导管是否误入颈内静脉的简单实用床旁检测方法，值得推广。

关键词: 锁骨下静脉, 穿刺, 颈内静脉, 生理盐水冲击法

Abstract:

Normal saline flush procedure for bedside detection of misplaced subclavian vein catheter into the internal jugular vein        MA Jin-ping, WU Kai-ming, CAI Shi-rong,et al. Department of Gastrointestinal & Pancreatic Surgery，the First Affiliated Hospital，SunYat-sen University, Guangzhou 510080, China
Corresponding author: ZHAN Wen-hua, E-mail:wenhuazhan@medmail.com.cn
Abstract    Objective    To study the incidence of subclavian vein (SCV) catheter misplacement into the ipsilateral internal jugular vein (IJV) and evaluated feasibility of saline flush bedside procedure. Methods    179 gastrointestinal cancer patients underwent subclavian vein cannulation on the right side by an infraclavicular approach at First Hospital of Sun Yat-sen University from January 2008 to March 2010. After placement of subclavian vein catheter, 10 ml of normal saline was injected in the distal port of catheter, while anterior angle of ipsilateral neck was palpated by the operator or an independent observer. A thrill of fluid elicited on the palm of hand ( positive) was suggestive of misplaced catheter into ipsilateral IJV. All patients were confirmed with chest computed radiography(CR) . Results    7 patients were excluded from the study because of the unsuccessful cannulation. In nine patients（5.23%）, the catheter tip was located in the ipsilateral IJV. There were no false-positive or false-negative test results. There were 12 (6.98%) misplacements as detected by chest CR; 9 entered the IJV (5.23%) and 3 into the right atrium. (1.74%). Conclusion Normal saline flush procedure is a simple and sensitive bedside test that successfully detects misplaced SCV catheters into ipsilateral IJV.

Key words: subclavian vein catheter, internal jugular vein, catheter misplacement, complications, normal saline flush procedure