Akụkọ ihe mere eme nke Central venous access
1. 1929: Dọkịta na-awa German bụ Werner Forssmann debere eriri urinary site na vein aka ekpe nke ihu cubital, wee gosi na X-ray na catheter banyere n'aka nri atrium.
2. 1950: Central venous catheters ka emepụtara n'ọtụtụ dị ka nhọrọ ọhụrụ maka ịnweta etiti.
3. 1952: Aubaniac tụrụ aro ka mgbapu akwara subclavian, Wilson mechara tụpụta CVC catheterization dabere na vein subclavian.
4. 1953: Sven-Ivar Seldinger tụrụ aro ka dochie agịga siri ike na igwe ntuziaka waya ndu catheter maka venipuncture dị n'akụkụ, usoro Seldinger wee bụrụ teknụzụ mgbanwe maka ntinye oghere catheter etiti.
5. 1956: Forssmann, Cournand, Richards nwetara Nrite Nobel na Medicine maka ntinye aka ha na nhazi nke obi.
6. 1968: Akụkọ mbụ n'asụsụ bekee nke ime ime jugular venous maka nleba anya nrịbama venous.
7. 1970: Ebu ụzọ chepụta echiche nke catheter ọwara
8. 1978: Venous Doppler chọta maka n'ime jugular vein ahụ elu akara.
9. 1982: Ojiji nke ultrasound na-eduzi ohere nke etiti venous bụ Peters et al.
10. 1987: Wernecke et al mbụ kọrọ na iji ultrasound chọpụta pneumothorax.
11. 2001: The Bureau of Health Research and Quality Evidence Reporting depụtara Central venous access point of-care ultrasound dị ka otu n'ime 11 omume kwesịrị ka a gbasaa ebe niile.
12. 2008: American College of Emergency Physicians depụtara ultrasound-eduzi Central venous ohere dị ka "isi ma ọ bụ isi ihe mberede ultrasound ngwa"
13.2017: Amir et al na-atụ aro na enwere ike iji ultrasound kwado ọnọdụ CVC ma wepụ pneumothorax iji chekwaa oge ma hụ na izi ezi.
Nkọwa nke ohere nke etiti venous
1. CVC n'ozuzu na-ezo aka na ntinye nke catheter n'ime akwara etiti site na akwara jugular dị n'ime, vein subclavian na vein femoral, na-emekarị n'ọnụ nke catheter dị na elu vena cava, usụhọde vena cava, caval-atrial junction, aka nri atrium ma ọ bụ brachiocephalic vein, n'etiti nke elu vena cava.Venous ma ọ bụ oghere-atrial junction ka mma
2. Ntinye n'akụkụ oghere etiti venous catheter bụ PICC
3. A na-ejikarị ohere venous Central maka:
a) Ngwunye nke vasopressin, inositol, wdg.
b) Kateter buru ibu maka ntinye nke mmiri ntughari na ngwaahịa ọbara
c) Nnukwu catheter maka ọgwụgwọ nnọchi akụrụ ma ọ bụ ọgwụgwọ mgbanwe plasma
d) Nlekọta nri ndị nne na nna
e) Ọgwụ nje nje ma ọ bụ chemotherapy ogologo oge
f) catheter jụrụ oyi
g) Sheaths ma ọ bụ catheters maka ahịrị ndị ọzọ, dị ka pulmonary artery catheters, pacing wires na endovascular usoro ma ọ bụ maka usoro ntinye obi, wdg.
Ụkpụrụ bụ isi nke ntinye CVC nke ultrasound na-eduzi
1.Assumptions nke omenala CVC cannulation dabere na anatomical akara: atụ anya vaskụla anatomy na patency nke veins.
2. Ụkpụrụ nke Ntuziaka Ultrasound
a) Anatomical mgbanwe: vein ọnọdụ, ahụ n'elu anatomical akara onwe ha;ultrasound na-enye ohere nleba anya n'ezie na nyocha nke arịa na akụkụ ahụ dị n'akụkụ
b) Ọkpụkpụ akwara: ultrasonography tupu ị rụọ ọrụ nwere ike ịchọpụta thrombosis na stenosis n'oge (karịsịa na ndị ọrịa na-arịa ọrịa siri ike nwere nnukwu ọrịa thrombosis miri emi)
c) Nkwenye nke vein etinyere na ntinye n'ọnụ catheter: nleba anya n'otu oge nke ntinye akwụkwọ ntuziaka na vein, brachiocephalic vein, vena cava dị ala, atrium aka nri ma ọ bụ vena cava dị elu.
d) Mbelata nsogbu: thrombosis, tamponade obi, mgbaji akwara, hemothorax, pneumothorax.
Nhọrọ nyocha na akụrụngwa
1. Njirimara akụrụngwa: 2D oyiyi bụ ihe ndabere, agba Doppler na pulsed Doppler nwere ike ịmata ọdịiche dị n'etiti akwara na veins, njikwa ndekọ ahụike dịka akụkụ nke ndekọ ahụike ndị ọrịa, mkpuchi nyocha / coupplant na-eme ka ọ dịpụrụ adịpụ
2. Nhọrọ nyocha:
a) Ntinye: eriri ime ime na akwara femoral na-abụkarị 1-4 cm miri n'okpuru akpụkpọ ahụ, akwara subclavian chọrọ 4-7 cm.
b) mkpebi kwesịrị ekwesị na nhazi a na-elekwasị anya
c) Nyocha obere nha: 2 ~ 4cm n'obosara, dị mfe ịhụ ogologo na mkpụmkpụ axes nke arịa ọbara, dị mfe itinye nyocha na agịga.
d) 7 ~ 12MHz obere linear n'usoro a na-ejikarị eme ihe;obere convex n'okpuru clavicle, nyocha osisi hockey ụmụaka
Ụzọ mkpụmkpụ-axis na usoro ogologo-axis
Mmekọrịta dị n'etiti nyocha na agịga na-ekpebi ma ọ nọ n'ụgbọ elu ma ọ bụ n'ụgbọelu
1. Enweghị ike ịhụ ọnụ ọnụ agịga n'oge a na-arụ ọrụ, ọ dịkwa mkpa ka a chọpụta ọnọdụ nke n'ọnụ agịga site n'iji ike na-emegharị nyocha ahụ;uru: mkpirisi mmụta dị mkpirikpi, ileba anya nke ọma nke anụ ahụ perivascular, na ntinye dị mfe nke nyocha maka ndị abụba na olu dị mkpụmkpụ;
2. Enwere ike ịhụ ahụ agịga zuru oke na ọnụ agịga n'oge ọrụ;ọ na-esiri ike idobe arịa ọbara na agịga n'ime ụgbọ elu ihe onyonyo nke ultrasound mgbe niile
static na ike
1. Usoro static, ultrasound na-eji naanị maka nyocha tupu ịwa ahụ na nhọrọ nke ntinye ntinye agịga
2. Dynamic usoro: ezigbo oge ultrasound-eduzi puncture
3. Usoro akara elu ahụ <ụkpụrụ static < usoro dị ike
Ntunye CVC na-eduzi Ultrasound na catheterization
1. Nkwadebe tupu ịwa ahụ
a) Ndebanye aha ozi onye ọrịa iji dobe ndekọ eserese
b) Nyochaa saịtị ahụ a ga-akụtu iji kwado anatomy na patency, wee chọpụta atụmatụ ịwa ahụ.
c) Gbanwee uru onyonyo, omimi, wdg iji nweta ọnọdụ onyonyo kacha mma
d) Debe akụrụngwa ultrasound iji hụ na ebe ntụpọ, nyocha, ihuenyo na ahịrị anya bụ collinear.
2. Intraoperative nkà
a) A na-eji saline physiological mee ihe n'elu akpụkpọ ahụ kama iji gbochie couplant ịbanye n'ime ahụ mmadụ.
b) Aka na-adịghị achị na-ejide nyocha ahụ nke nta nke nta ma dabere na ntachi obi megide onye ọrịa maka nkwụsi ike.
c) Debe anya gị na ihuenyo ultrasound, ma nwee mmetụta mgbanwe nrụgide nke agịga jiri aka gị zighachi azụ (mmetụta ọdịda)
d) Ewebata waya ndu: Onye edemede na-atụ aro ka etinye ma ọ dịkarịa ala 5 cm nke waya ndu n'ime ụgbọ mmiri etiti (ya bụ, waya ntuziaka kwesịrị ịdịkarịa ala 15 cm site na oche agịga);Mkpa ịbanye 20 ~ 30cm, ma waya ndu na-abanye n'ime miri emi, ọ dị mfe ime ka arrhythmia.
e) Nkwenye nke ọnọdụ nke waya ndu: Nyochaa n'akụkụ axis dị mkpirikpi na ogologo axis nke arịa ọbara site na njedebe dị anya, ma soro ọnọdụ nke waya nduzi.Dịka ọmụmaatụ, mgbe a na-agbaji akwara jugular dị n'ime, ọ dị mkpa iji gosi na waya nduzi na-abanye na vein brachiocephalic.
f) Mee obere mbepụ ya na akpụkpọ anụ tupu ịgbasa ya, dilator na-agafe anụ ahụ niile dị n'ihu arịa ọbara, ma zere ịkụnye arịa ọbara.
3. Ọnyà Cannulation Jugular Vein
a) Mmekọrịta dị n'etiti akwara carotid na akwara jugular dị n'ime: N'ụzọ anụ ahụ, akwara jugular dị n'ime na-adịkarị n'èzí akwara.N'oge nyocha nke axis dị mkpụmkpụ, n'ihi na olu dị okirikiri, nyocha n'ọnọdụ dị iche iche na-etolite akụkụ dị iche iche, veins na arteries nwere ike ime.Ihe omume.
b) Nhọrọ nke ntinye agịga: oghere tube dị nso dị ukwuu, ma ọ dị nso na ngụgụ, na ihe ize ndụ nke pneumothorax dị elu;a na-atụ aro ka ị nyochaa iji gosi na arịa ọbara dị na ntinye agịga bụ 1 ~ 2cm miri emi site na akpụkpọ ahụ
c) Nyochaa akwara niile dị n'ime ahụ tupu oge eruo, nyochaa nhazi ahụ na patency nke arịa ọbara, zere thrombus na stenosis na ebe mgbapu ma kewapụ ya na akwara carotid.
d) Zere nkwụsị nke akwara carotid: Tupu vasodilation, ebe nkwụsịtụ na ọnọdụ nke waya nduzi kwesịrị ikwenye n'echiche ogologo na mkpụmkpụ.Maka ihe nchekwa, ọ dị mkpa ka a hụ ogologo axis nke waya ntuziaka na vein brachiocephalic.
e) Ịtụgharị isi: Usoro nrịbama nke ọdịnala na-atụ aro ịtụgharị isi ka ọ pụta ìhè na akwara sternocleidomastoid na-egosi akara na ikpughe na idozi akwara jugular dị n'ime, mana ịtụgharị isi n'ogo 30 nwere ike ime ka akwara jugular dị n'ime na akwara carotid gbakọta karịa karịa. 54%, na ntinye aka ultrasound agaghị ekwe omume.A na-atụ aro ka ịtụgharị
4.Subclavian vein catheterization
a) Ekwesiri ighota na nyocha nke ultrasound nke vein subclavian siri ike
b) Uru: Ọnọdụ anatomical nke vein bụ nke a pụrụ ịdabere na ya, nke dị mma maka ịkụtu ụgbọ elu.
c) Nkà: A na-etinye nyocha ahụ n'akụkụ clavicle dị na fossa dị n'okpuru ya, na-egosi echiche dị mkpụmkpụ, na nyocha ahụ ji nwayọọ nwayọọ na-agbada n'etiti;N'ụzọ nkà na ụzụ, a na-agbaji akwara axillary ebe a;tụgharịa nyocha 90 ogo iji gosi ogologo axis anya nke arịa ọbara, nyocha ahụ na-agbadata ntakịrị n'isi;mgbe emechara nyocha ahụ, a na-agbaji agịga ahụ n'etiti akụkụ nyocha ahụ, a na-etinyekwa agịga ahụ n'okpuru nduzi nke ultrasound ozugbo.
d) N'oge na-adịbeghị anya, ejirila obere microconvex puncture nke nwere obere oge dị ntakịrị iji duzie, nyocha ahụ pere mpe ma nwee ike ịhụ miri emi.
5. catheterization nke femoral vein
a) Uru: Wepụ na traktị iku ume na akụrụngwa nlekota, ọ dịghị ihe ize ndụ nke pneumothorax na hemothorax.
b) Enweghị ọtụtụ akwụkwọ na ntinye aka ultrasound.Ụfọdụ ndị mmadụ na-eche na ọ bụ ihe a pụrụ ịdabere na ya iji ihe nrịbama doro anya gbado elu ahụ, mana ultrasound adịghị arụ ọrụ.Ntuziaka Ultrasound dabara nke ọma maka mgbanwe mgbanwe anatomical FV na njide obi.
c) Ndozi ụkwụ frog na-ebelata nkuchi elu nke FV na FA, welie isi ma gbatịa ụkwụ n'èzí iji gbasaa lumen venous.
d) Usoro ahụ bụ otu maka mgbapu akwara jugular ime
Nduzi ultrasound obi obi n'ọnọdu waya
1. TEE obi ultrasound nwere ebe kachasị mma n'ọnụ, mana ọ na-emebi emebi na enweghị ike iji ya mee ihe mgbe niile.
2. Usoro nkwalite ọdịiche: jiri microbubbles na saline nkịtị na-ama jijiji dị ka onye na-ahụ maka ọdịiche, ma banye na atrium ziri ezi n'ime 2 sekọnd mgbe mpụpụ laminar si na catheter n'ọnụ.
3. Na-achọ ahụmịhe dị ukwuu na nyocha nke ultrasound obi, mana enwere ike igosipụta ya ozugbo, mara mma
Nyocha ultrasound nke akpa ume iji wepụ pneumothorax
1. Ultrasound-eduzi Central venous puncture ọ bụghị nanị na-ebelata ọnọdụ nke pneumothorax, kamakwa ọ nwere mmetụta dị elu na nkọwa maka nchọpụta pneumothorax (dị elu karịa X-ray obi)
2. A na-atụ aro ka itinye ya n'ime usoro nkwenye postoperative, nke nwere ike ịlele ngwa ngwa na n'ụzọ ziri ezi n'akụkụ akwa.Ọ bụrụ na ejikọtara ya na akụkụ gara aga nke ultrasound obi, a na-atụ anya na ọ ga-ebelata oge echere maka iji catheter.
3. ultrasound akpa ume: (ozi mgbakwunye mpụga, maka naanị ntụaka)
Foto ngụgụ nkịtị:
Ahịrị A: Ahịrị hyperechoic nke pleural nke na-eku ume, na-esochi ọtụtụ ahịrị ya na ya, nha nhata, na attenuated na omimi, ya bụ, ngụgụ na-amị amị.
M-ultrasound gosipụtara na ahịrị hyperechoic na-emegharị na ntụziaka nke nyocha na iku ume dị ka oké osimiri, na pectoral ebu ahịrị dị ka ájá, ya bụ, akara osimiri.
N'ụfọdụ ndị nkịtị, oghere intercostal ikpeazụ dị n'elu diaphragm nwere ike ịchọpụta ihe na-erughị 3 laser beam-dị ka onyonyo sitere na ahịrị pectoral ebu, na-agbatị kwụ ọtọ na ala ihuenyo ahụ, na-emegharị ahụ na iku ume — ahịrị B.
Foto pneumothorax:
Ahịrị B na-apụ n'anya, mịfe ngụgụ na-apụ n'anya, ma jiri akara koodu dochie akara osimiri.Na mgbakwunye, a na-eji akara akara ngụgụ iji chọpụta oke pneumothorax, ebe ngụgụ na-apụtakwa ebe akara osimiri na akara barcode na-apụta ọzọ.
Ọzụzụ CVC na-eduzi Ultrasound
1. Enweghị nkwekọrịta na ụkpụrụ ọzụzụ na asambodo
2. Echiche na usoro ntinye kpuru ìsì na-efunahụ na ịmụta usoro ultrasound dị;Otú ọ dị, ka usoro ultrasound na-agbasawanyewanye, nhọrọ n'etiti nchekwa ndị ọrịa na nlekọta nke usoro ndị nwere ike ọ gaghị adị ka a ga-eji mee ihe ga-atụle.
3. A ga-enyocha nyocha nke ikike ụlọ ọgwụ site na ilele omume ụlọ ọgwụ kama ịdabere na ọnụọgụ nke usoro.
na ngwụcha
Isi ihe na-arụ ọrụ nke ọma na nchekwa nke ultrasound-eduzi CVC bụ ịmara ọnyà na njedebe nke usoro a na mgbakwunye na ọzụzụ kwesịrị ekwesị.
Oge nzipu: Nov-26-2022
