Nhoroondo yepakati venous kuwana
1. 1929: Chiremba wokuGermany Werner Forssmann akaisa catheter yeweti kubva kuruboshwe rworuboshwe anterior cubital tsinga, uye akasimbisa neX-ray kuti catheter yakapinda muatrium yakarurama.
2. 1950: Central venous catheter inogadzirwa-zhinji senge sarudzo nyowani yepakati pekupinda.
3. 1952: Aubaniac akakurudzira subclavian vein puncture, Wilson akazokurudzira CVC catheterization inobva pa subclavian vein.
4. 1953: Sven-Ivar Seldinger akaronga kutsiva iyo tsono yakaoma nesimbi inotungamira waya inotungamira catheter yekuvharisa venipuncture, uye nzira yeSeldinger yakava tekinoroji yekuchinja kwepakati venous catheter kuiswa.
5. 1956: Forssmann, Cournand, Richards akahwina Mubairo weNobel muMishonga nokuda kwekubatsira kwavo kumwoyo catheterization.
6. 1968: Chirevo chekutanga muChirungu chemukati jugular venous kuwana yepakati venous pressure monitoring.
7. 1970: Pfungwa yetunnel catheter yakatanga kutaurwa
8. 1978: Venous Doppler locator yemukati jugular tsinga yemuviri inomaka
9. 1982: Kushandiswa kwe ultrasound kutungamirira pakati pevheni yekuwana kwakatanga kutaurwa naPeter et al.
10. 1987: Wernecke et al vakatanga kuzivisa kushandiswa kwe ultrasound kuona pneumothorax.
11. 2001: The Bureau of Health Research and Quality Evidence Reporting inonyora central venous access point-of-care ultrasound seimwe yezviito gumi nerimwe zvakakodzera kusimudzirwa kwakapararira.
12. 2008: American College of Emergency Physicians inoronga ultrasound-inotungamirirwa nechepakati venous kuwana se "core kana primary emergency ultrasound application"
13.2017: Amir et al vanoratidza kuti ultrasound inogona kushandiswa kusimbisa nzvimbo yeCVC uye kusabvisa pneumothorax kuchengetedza nguva uye kuve nechokwadi.
Tsanangudzo yepakati venous kupinda
1. CVC kazhinji inoreva kuiswa kwekateti mukati memukati wepakati kuburikidza nemukati wejugular vein, subclavian vein uye femoral vein, kazhinji muromo we catheter unowanikwa mune yepamusoro vena cava, inferior vena cava, caval-atrial junction, right atrium kana brachiocephalic vein, pakati peiyo yepamusoro vena cava.Venous kana cavity-atrial junction inosarudzwa
2. Peripherally yakaiswa pakati venous catheter is PICC
3. Central venous access inonyanya kushandiswa kune:
a) Ijekiseni yakadzika yevasopressin, inositol, nezvimwe.
b) Makateta mahombe ekupinza mvura yekumutsidzira uye zvigadzirwa zveropa
c) Hombe yakaboora catheter yerenal replacement therapy kana plasma exchange therapy
d) Kutarisira kudya kwevabereki
e) Nguva refu inorwisa mabhakitiriya kana chemotherapy mishonga yemishonga
f) Catheter yekutonhodza
g) Sheaths kana catheter yemamwe mitsara, senge pulmonary artery catheter, pacing waya uye endovascular maitiro kana yemoyo kupindira maitiro, nezvimwe.
Nheyo dzekutanga dze ultrasound-inotungamirwa CVC yekuisa
1. Mafungidziro echinyakare CVC cannulation zvichibva pane anatomical landmarks: inotarisirwa vascular anatomy uye patency yetsinga.
2. Nheyo dzeUltrasound Guidance
a) Anatomical variation: nzvimbo yetsinga, muviri wepamusoro anatomical mamaki ivo pachavo;ultrasound inobvumira chaiyo-nguva yekuona uye kuongororwa kwemidziyo uye yakatarisana anatomy
b) Vascular patency: Preoperative ultrasonography inogona kuona thrombosis uye stenosis munguva (kunyanya muvarwere vanorwara zvakanyanya vane chiitiko chakanyanya cheyakadzika vein thrombosis)
c) Simbiso yekuisa tsinga uye catheter tip chinzvimbo: chaiyo-nguva yekutarisa yekupinda mutsinga, brachiocephalic vein, inferior vena cava, right atrium kana yepamusoro vena cava.
d) Kuderedza matambudziko: thrombosis, cardiac tamponade, arterial puncture, hemothorax, pneumothorax
Probe uye Equipment Sarudzo
1. Equipment features: 2D mufananidzo ndiyo hwaro, ruvara Doppler uye pulsed Doppler anogona kusiyanisa pakati arteries uye tsinga, rekodhi rekodhi rekodhi sechikamu chevarwere marekodhi ekurapa, sterile probe chivharo / couplant inovimbisa kuparadzaniswa kusina hutachiona.
2. Sarudzo yekuongorora:
a) Kupinda: Iyo yemukati jugular uye femoral tsinga dzinowanzo 1-4 cm kudzika pasi peganda, uye subclavian vein inoda 4-7 cm.
b) kugadzirisa kwakakodzera uye inogadziriswa kutarisa
c) Diki saizi probe: 2 ~ 4cm yakafara, iri nyore kuona marefu uye mapfupi matemo emidziyo yeropa, nyore kuisa probe netsono.
d) 7 ~ 12MHz diki mutsara mutsara unowanzo shandiswa;diki convex pasi pe clavicle, vana hockey tsvimbo probe
Short-axis nzira uye refu-axis nzira
Hukama huri pakati pekuferefeta netsono hunosarudza kuti iri mundege here kana kuti kunze kwendege
1. Mushonga wetsono haugone kuonekwa panguva yekushanda, uye nzvimbo yepini yetsono inoda kugadziriswa nekushandura zvine simba probe;zvakanakira: kupfupika kwekudzidza curve, kutarisisa kuri nani kweperivascular tissue, uye nyore kuiswa kweprobe kune vanhu vane mafuta uye mitsipa mipfupi;
2. Muviri wetsono wakakwana uye tsono yetsono inogona kuonekwa panguva yekushanda;zvinonetsa kuchengetedza tsinga netsono mundege ye ultrasound imaging nguva dzese
static uye simba
1. Static nzira, ultrasound inongoshandiswa pa preoperative assessment uye kusarudzwa kwetsono kuisa pfungwa
2. Dynamic nzira: chaiyo-nguva ultrasound-inotungamirirwa puncture
3. Body surface marking method < static method < dynamic method
Ultrasound-inotungamirwa CVC puncture uye catheterization
1. Preoperative kugadzirira
a) Kunyoresa ruzivo rwemurwere kuchengetedza marekodhi echati
b) Skena saiti kuti iburitswe kusimbisa vascular anatomy uye patency, uye kuona chirongwa chekuvhiya.
c) Gadzirisa mufananidzo kuwana, kudzika, nezvimwe kuti uwane yakanakisa mufananidzo mamiriro
d) Isa iyo ultrasound midziyo kuti uone kuti iyo puncture point, probe, skrini uye mutsara wekuona zviri colinear.
2. Unyanzvi hwekushanda
a) Physiological saline inoshandiswa pamusoro peganda panzvimbo ye couplant kudzivirira iyo couplant kupinda mumuviri wemunhu.
b) Ruoko rusina simba runobata probe zvinyoro nyoro uye rwakazembera kumurwere kuti agadzikane.
c) Chengetedza maziso ako akatarira pachiratidziro che ultrasound, uye unzwe kudzvanywa kunotumirwa netsono nemaoko ako (kunzwa kukundikana)
d) Kusuma waya yegwara: Munyori anokurudzira kuti ingangoita masendimita mashanu ewaya yegwara iiswe mumudziyo wepakati wetsinga (kureva, waya yegwara inofanira kunge iri masendimita gumi nemashanu kubva pachigaro chetsono);Inoda kupinda 20 ~ 30cm, asi gidhi waya inopinda yakadzika, zviri nyore kukonzera arrhythmia.
e) Simbiso yenzvimbo yewaya yekutungamira: Skena uchitevedza axis ipfupi uyezve axis refu yemudziyo weropa kubva kumucheto wakareba, uye tarisa pakamira waya yekutungamira.Semuenzaniso, kana mutsinga wemukati wejugular wakaputirwa, zvakakosha kusimbisa kuti tambo yekufambisa inopinda mubrachiocephalic vein.
f) Gadzira diki ne scalpel usati wadhirowa, dilator inopinda nepakati pese matishu pamberi pemudziyo weropa, asi dzivisa kubaya tsinga yeropa.
3. Internal Jugular Vein Cannulation Trap
a) Hukama huri pakati pecarotid artery uye yemukati jugular vein: Anatomically, iyo yemukati jugular tsinga inowanzowanikwa kunze kwetsinga.Munguva pfupi-axis scanning, nokuti mutsipa wakatenderera, kuongorora panzvimbo dzakasiyana kunoumba makona akasiyana, uye tsinga dzinoputika uye tsinga dzinogona kuitika.Phenomenon.
b) Kusarudzwa kwepini yepini yetsono: iyo proximal tube diameter yakakura, asi iri pedyo nemapapu, uye njodzi yepneumothorax yakakwirira;zvinokurudzirwa kuti utarise kuti uone kuti tsinga yeropa painopinza tsono ndeye 1 ~ 2cm kudzika kubva paganda.
c) Skena iyo yese yemukati jugular tsinga pachine nguva, ongorora anatomy uye patency yemudziyo weropa, dzivirira thrombus uye stenosis painobowa uye iparadzanise kubva kune carotid artery.
d) Dzivisa carotid artery puncture: Pamberi pevasodilation, iyo puncture point uye chinzvimbo chegwara wire inoda kusimbiswa mune refu uye pfupi axis maonero.Nezvikonzero zvekuchengetedza, mufananidzo wakareba weakisi yewaya inotungamira inoda kuonekwa mubrachiocephalic vein.
e) Kutenderedza musoro: Nzira yechinyakare yekumaka puncture inokurudzira kutenderedza musoro kuratidza sternocleidomastoid muscle yekumaka uye kuburitsa uye kugadzirisa mukati mejugular tsinga, asi kutenderedza musoro 30 madhigirii kunogona kuita kuti mukati mejugular vein uye carotid artery ipindirane nekupfuura. 54%, uye ultrasound-inotungamirirwa puncture haigoneki.Inokurudzirwa kutendeuka
4.Subclavian vein catheterization
a) Izvo zvinofanirwa kucherechedzwa kuti iyo ultrasound scan ye subclavian vein yakatiomei
b) Mabhenefiti: Iyo anatomical chinzvimbo chetsinga yakavimbika, iri nyore kune-mu-ndege puncture.
c) Unyanzvi: Iyo probe inoiswa pamwe neclavicle mufossa iri pazasi payo, ichiratidza pfupi-axis maonero, uye probe inotsvedza zvishoma nezvishoma ichidzika nepakati;zvehunyanzvi, axillary tsinga yakaboorwa pano;shandura probe 90 degrees kuratidza maonero akareba-axis yemudziyo weropa, probe inotenderera zvishoma kune musoro;mushure mekunge probe yagadzikana, tsono inobaiwa kubva pakati pedivi rekuferefeta, uye tsono inoiswa pasi peiyo chaiyo-nguva ultrasound kutungamira.
d) Munguva pfupi yapfuura, diki diki diki puncture ine yakaderera frequency yakashandiswa kutungamira, uye probe idiki uye inogona kuona zvakadzika.
5. Femoral vein catheterization
a) Zvakanakira: Ramba kure nekufema turakiti uye yekutarisa michina, hapana njodzi yepneumothorax uye hemothorax.
b) Iko hakuna mabhuku akawanda pane ultrasound-inotungamirwa puncture.Vamwe vanhu vanofunga kuti zvakavimbika kubaya muviri nezviratidzo zviri pachena, asi Ultrasound haina basa.Ultrasound kutungamira yakanyatsokodzera FV anatomical variation uye kusungwa kwemoyo.
c) Kumira kwegumbo redatya kunoderedza kupindirana kwepamusoro peFV neFA, kunosimudza musoro nekutambanudza makumbo kunze kuti kukwidze venous lumen.
d) Maitiro acho akafanana neyemukati jugular tsinga puncture
Cardiac ultrasound inotungamira waya yekumisikidza
1. TEE cardiac ultrasound ine yakanyatsokodzera tip positioning, asi inokuvadza uye haigone kushandiswa semazuva ese.
2. Kusiyanisa nzira yekusimudzira: shandisa ma microbubbles mukuzunungusa yakajairika saline sechinhu chinosiyanisa, uye pinda muatrium yekurudyi mukati memasekonzi maviri mushure me laminar kuyerera ejection kubva kune catheter tip.
3. Inoda ruzivo rwakakura mu cardiac ultrasound scanning, asi inogona kusimbiswa munguva chaiyo, inoyevedza.
Lung ultrasound scan kuti ibvise pneumothorax
1. Ultrasound-inotungamirirwa nechepakati pevhavha inopinza kwete chete kuderedza kuitika kwepneumothorax, asiwo ine yakanyanya kunzwisisika uye yakananga yekuona pneumothorax (yakakwirira kupfuura chifuva X-ray)
2. Zvinokurudzirwa kuti zvibatanidze mu postoperative yekusimbisa nzira, iyo inogona kukurumidza uye yakarurama kutarisa pamubhedha.Kana iyo yakabatanidzwa nechikamu chekare che cardiac ultrasound, inotarisirwa kupfupisa nguva yekumirira yekushandiswa kwecatheter.
3. Lung ultrasound: (ruzivo rwekunze rwekuwedzera, rwekutarisa chete)
Mufananidzo wemapapu wakajairika:
Mutsara A: Mutsetse wepleural hyperechoic unotsvedza nekufema, uchiteverwa nemitsara yakawanda inofambirana nawo, yakaenzana, uye yakanyungudutswa nekudzika, ndiko kuti, kutsvedza kwemapapu.
M-ultrasound yakaratidza kuti mutsara we hyperechoic unodzokorora munzira yeprobe nekufema wakanga wakaita segungwa, uye pectoral mold line yakanga yakafanana nejecha, kureva, chiratidzo chegungwa.
Mune vamwe vanhu vakajairwa, iyo yekupedzisira intercostal nzvimbo pamusoro pe diaphragm inogona kuona isingasviki 3 laser beam-senge mifananidzo ichibva pamutsetse wepectoral mold, ichitambanuka pazasi pechidzitiro, uye ichidzokorora nekufema-B mutsara.
Mufananidzo wePneumothorax:
Mutsara weB unonyangarika, kutsvedza kwemapapu kunonyangarika, uye chiratidzo chemahombekombe chinotsiviwa nebhakodhi chiratidzo.Mukuwedzera, chiratidzo chemapapu chinoshandiswa kuona huwandu hwepneumothorax, uye nzvimbo yemapapu inoonekwa apo chiratidzo chemahombekombe uye chiratidzo chebhakodhi chinooneka.
Ultrasound-inotungamirwa CVC Kudzidziswa
1. Kushaikwa kwekubvumirana pane zvekudzidziswa uye zvitupa zviyero
2. Maonero ekuti maitiro ekuisa mapofu anorasika mukudzidza maitiro e ultrasound aripo;zvisinei, sezvo maitiro e ultrasound anowedzera kupararira, sarudzo pakati pekuchengetedzwa kwevarwere uye kuchengetedza nzira dzinogona kunge dzisinganyanyi kushandiswa dzinofanira kufungwa.
3. Kuongororwa kwehunyanzvi hwekiriniki kunofanirwa kupihwa nekucherechedza maitiro ekiriniki pane kuvimba nehuwandu hwemaitiro.
mukupedzisa
Kiyi yekushanda uye yakachengeteka ultrasound-inotungamirwa CVC kuziva zvipingamupinyi uye zvisingakwanisi zveiyi tekinoroji mukuwedzera pakudzidziswa kwakakodzera.
Nguva yekutumira: Nov-26-2022
