Imbali yofikelelo lwe-venous esembindini
1. Ngowe-1929: Ugqirha wotyando waseJamani uWerner Forssmann wafaka umbhobho wokuchama kumthambo we-cubital osekhohlo ongaphambili, waza waqinisekisa ngeX-reyi ukuba i-catheter yangena kwiatrium engasekunene.
2. 1950: I-Catheter ye-venous ephakathi ziveliswa ngobuninzi njengendlela entsha yokufikelela kwindawo
3. 1952: I-Aubaniac ecetywayo i-subclavian vein puncture, uWilson emva koko wacebisa i-CVC catheterization esekelwe kwi-subclavia vein.
4. 1953: U-Sven-Ivar Seldinger ucebise ukuba atshintshe inaliti elukhuni kunye nesikhokelo sentsimbi yesikhokelo socingo lwecatheter ye-peripheral venipuncture, kunye nobuchule be-Seldinger baba bubuchwepheshe obuguqukayo bokubekwa kwe-venous catheter ephakathi.
5. 1956: Forssmann, Cournand, Richards baphumelela iBhaso leNobel kuNyango ngegalelo labo kwi-catheterization yentliziyo.
6. 1968: Ingxelo yokuqala ngesiNgesi yokufikelela kwi-jugular ye-venous yangaphakathi yokuhlola uxinzelelo lwe-venous ephakathi.
7. 1970: Ingqikelelo ye-tunnel catheter yacetywa kuqala
8. 1978: I-Venous Doppler indawo yokumakishwa komphezulu womzimba we-jugular wangaphakathi.
9. 1982: Ukusetyenziswa kwe-ultrasound ukukhokela ukufikelela kwe-venous ephakathi kwabikwa okokuqala nguPeters et al.
10. 1987: UWernecke et al waqala wabika ukusetyenziswa kwe-ultrasound ukufumanisa i-pneumothorax
11. 2001: I-Bureau of Health Research and Quality Evidence Reporting idwelisa i-venous access point-of-care ultrasound njengenye yezenzo ze-11 ezifanele ukukhuthazwa ngokubanzi.
12. 2008: I-American College of Emergency Physicians idwelisa i-ultrasound-guided central venous access as "core or primary emergency ultrasound application"
I-13.2017: U-Amir et al ucebisa ukuba i-ultrasound ingasetyenziselwa ukuqinisekisa indawo ye-CVC kwaye ingabandakanyi i-pneumothorax ukugcina ixesha kunye nokuqinisekisa ukuchaneka
Inkcazo yofikelelo lwe-venous esembindini
1. I-CVC ngokuqhelekileyo ibhekisela ekufakweni kwe-catheter kwi-vein ephakathi ngokusebenzisa i-jugular vein yangaphakathi, i-subclavian vein kunye ne-femoral vein, ngokuqhelekileyo incam ye-catheter ifumaneka kwi-high vena cava, i-inferior vena cava, i-caval-atrial junction, i-atrium yasekunene okanye i-brachiocephalic vein, phakathi kwayo i-vena cava ephezulu.I-venous okanye i-cavity-atrial junction iyakhethwa
2. I-peripheral efakwe kumbindi we-venous catheter yi-PICC
3. Ufikelelo lwe-venous esembindini lusetyenziswa ikakhulu:
a) Inaliti egxininisiweyo ye-vasopressin, inositol, njl.
b) Iicatheter ezinkulu zokugalela ulwelo lokuphefumla kunye neemveliso zegazi
c) Umbhobho omkhulu wecatheter yonyango lokubuyisela izintso okanye unyango lokutshintshiselana ngeplasma
d) Ulawulo lwesondlo sabazali
e) Unyango lwexesha elide lokubulala iintsholongwane okanye unyango lwechemotherapy
f) Ikhethetha yokupholisa
g) I-Sheaths okanye i-catheters yeminye imigca, efana ne-pulmonary artery catheters, i-pacing wire kunye ne-endovascular procedures okanye iinkqubo zokungenelela kwi-cardiac, njl.
Imigaqo esisiseko yokubeka i-CVC ekhokelwa yi-ultrasound
I-1. Iingqikelelo ze-CVC zendabuko ezisekelwe kwi-anatomical landmarks: kulindeleke i-vascular anatomy kunye ne-patency ye-veins.
2. Imigaqo ye-Ultrasound Guidance
a) Ukwahluka kwe-anatomical: indawo ehlala kuyo imithambo, iziphawuli zomphezulu womzimba ngokwazo;I-ultrasound ivumela ukubonwa kwexesha langempela kunye novavanyo lwemikhumbi kunye ne-anatomy ekufutshane
b) I-Vascular patency: I-ultrasonography yangaphambi kokuhlinzwa inokubona i-thrombosis kunye ne-stenosis ngexesha (ingakumbi kwizigulane ezigula kakhulu ezineziganeko eziphezulu ze-vein thrombosis)
c) Ukuqinisekiswa kwe-vein efakiweyo kunye ne-catheter tip positioning: ukubonwa kwexesha lokwenyani lokungena kwi-guidewire kwi-vein, i-brachiocephalic vein, i-inferior vena cava, i-atrium yasekunene okanye i-vena cava ephezulu.
d) Ukunciphisa iingxaki: i-thrombosis, i-tamponade yentliziyo, ukuhlatywa kwe-arterial, i-hemothorax, i-pneumothorax
Ukhetho kunye noKhetho lweZixhobo
1. Iimpawu zezixhobo: Umfanekiso we-2D sisiseko, umbala we-Doppler kunye ne-pulsed Doppler unokwahlula phakathi kwe-arteries kunye ne-veins, ulawulo lwerekhodi yonyango njengenxalenye yeerekhodi zonyango lwesigulane, inzalo yokukhusela i-probe / i-couplant iqinisekisa ukuhlukaniswa okuyinyumba.
2. Ukukhetha ukuvavanya:
a) Ukungena: I-jugular yangaphakathi kunye ne-femoral veins ihlala i-1-4 cm ubunzulu phantsi kwesikhumba, kwaye i-subclavia vein idinga i-4-7 cm.
b) isisombululo esifanelekileyo kunye nokugxila okulungelelanisiweyo
c) Ubungakanani obuncinci beprobe: 2 ~ 4cm ububanzi, kulula ukujonga i-axes ezinde nezimfutshane zemithambo yegazi, kulula ukubeka iprobe kunye nenaliti
d) 7 ~ 12MHz uluhlu oluncinci lomgca lusetyenziswa ngokubanzi;i-convex encinci phantsi kwe-clavicle, i-hockey stick probe yabantwana
Indlela ye-axis emfutshane kunye nendlela ye-long-axis
Ubudlelwane phakathi kweprobe kunye nenaliti bumisela ukuba i-plane okanye ingaphandle kwenqwelomoya
1. Incam yenaliti ayinakubonwa ngexesha lokusebenza, kwaye indawo yenaliti yenaliti kufuneka igqitywe ngokuguquguquka ngokuguquguqukayo kwiprobe;iingenelo: i-curve yokufunda emfutshane, ukujonga ngcono izicubu ze-perivascular, kunye nokubekwa lula kweprobe kubantu abatyebileyo kunye neentamo ezimfutshane;
2. Umzimba wenaliti opheleleyo kunye nencam yenaliti inokubonwa ngexesha lokusebenza;Kunzima ukugcina imithambo yegazi kunye neenaliti kwi-ultrasound imaging plane ngamaxesha onke
imile kwaye iguquguqukayo
1. Indlela ye-static, i-ultrasound isetyenziselwa kuphela uvavanyo lwangaphambili kunye nokukhethwa kwamanqaku okufakwa kweenaliti
2. Indlela yeDynamic: i-real-time ultrasound-guided puncture
3. Indlela yokumakisha umphezulu womzimba < indlela ye-static < indlela eguquguqukayo
I-Ultrasound-guided CVC puncture kunye ne-catheterization
1. Ukulungiselela kwangaphambili
a) Ubhaliso lweenkcukacha zesigulana ukugcina iirekhodi zetshathi
b) Skena indawo ekuza kuhlatywa kuyo ukuqinisekisa i-vascular anatomy kunye ne-patency, kunye nokumisela isicwangciso sotyando.
c) Lungisa ukuzuzwa komfanekiso, ubunzulu, njalo njalo ukufumana owona mfanekiso ulungileyo
d) Beka izixhobo ze-ultrasound ukuqinisekisa ukuba indawo yokubhoboza, i-probe, isikrini kunye nomgca wokubona ziyi-collinear
2. Izakhono ze-intraoperative
a) I-saline ye-Physiological isetyenziswa kumphezulu wolusu endaweni ye-couplant ukunqanda i-couplant ukuba ingangeni emzimbeni womntu.
b) Isandla esingalawulekiyo sibambe iprobe kancinci kwaye sayama kancinci kwisigulana ukuze sizinzise.
c) Gcina amehlo akho ethe ntsho kwiscreen se-ultrasound, kwaye uzive utshintsho loxinzelelo luthunyelwe ngenaliti ngezandla zakho (ukuziva ukusilela)
d) Ukwazisa ucingo lwesikhokelo: Umbhali ucebisa ukuba ubuncinci i-5 cm yocingo olukhokelayo lubekwe kwisitya esisembindini se-venous (oko kukuthi, ucingo lwesikhokelo kufuneka lube yi-15 cm ubuncinane ukusuka kwisihlalo senaliti);Udinga ukungena kwi-20 ~ 30cm, kodwa ucingo lwesikhokelo lungena nzulu, kulula ukubangela i-arrhythmia.
e) Ukuqinisekiswa kokuma kocingo lwesikhokelo: Skena ecaleni kwe-axis emfutshane kwaye emva koko i-axis ende yomkhumbi wegazi ukusuka ekupheleni okude, kwaye ulandele indawo yocingo lwesikhokelo.Ngokomzekelo, xa i-jugular vein yangaphakathi ihlanjululwa, kuyimfuneko ukuqinisekisa ukuba ucingo lwesikhokelo lungena kwi-brachiocephalic vein.
f) Yenza i-scalpel encinci nge-scalpel ngaphambi kokuhlanjululwa, i-dilator idlula kuzo zonke izihlunu eziphambi komthambo wegazi, kodwa kugweme ukugqobhoza umthambo wegazi.
3. I-Internal Jugular Vein Cannulation Trap
a) Ubudlelwane phakathi kwe-carotid artery kunye ne-jugular vein yangaphakathi: Ngokwe-anatomically, i-jugular vein yangaphakathi ibekwe ngokubanzi ngaphandle komthambo.Ngexesha lokuskena kwe-short-axis, kuba intamo ijikeleza, ukuskena kwiindawo ezahlukeneyo zenza ii-angles ezahlukeneyo, kwaye imithambo edibeneyo kunye nemithambo ingenzeka.Isiganeko.
b) Ukukhethwa kwendawo yokungena inaliti: i-proximal tube diameter inkulu, kodwa isondele kumphunga, kwaye umngcipheko we-pneumothorax uphezulu;Kuyacetyiswa ukuba uskene ukuqinisekisa ukuba umthambo wegazi kwindawo yokungena inaliti yi-1 ~ 2cm ubunzulu ukusuka eluswini.
c) Skena yonke i-jugular vein yangaphakathi kwangethuba, uvavanye i-anatomy kunye ne-patency ye-blood vessel, uthintele i-thrombus kunye ne-stenosis kwindawo yokubhoboza kwaye uhlukanise kwi-carotid artery.
d) Gwema i-carotid artery puncture: Ngaphambi kwe-vasodilation, indawo yokubhoboza kunye nendawo yocingo lwesikhokelo kufuneka iqinisekiswe kwiimbono ze-axis ende kunye nefutshane.Ngenxa yezizathu zokhuseleko, umfanekiso we-axis ende yocingo lwesikhokelo kufuneka ubonwe kwi-brachiocephalic vein.
e) Ukuguqula intloko: Indlela yendabuko yokumakisha i-puncture incoma ukuguqula intloko ukugqamisa ukuphawula kwemisipha ye-sternocleidomastoid kunye nokutyhila kunye nokulungisa umthambo we-jugular wangaphakathi, kodwa ukuguqula intloko ye-30 degrees kunokubangela ukuba i-jugular vein yangaphakathi kunye ne-carotid artery idibanise ngaphezulu I-54%, kunye ne-ultrasound-guided puncture ayinakwenzeka.Kunconywa ukujika
4.I-Subclavian vein catheterization
a) Kufuneka kuqatshelwe ukuba i-ultrasound scan ye-subclavia vein inzima ngandlela-thile
b) Izinto eziluncedo: Indawo ye-anatomical ye-vein inokwethenjelwa, elungele ukuhlatywa kwenqwelomoya.
c) Izakhono: I-probe ibekwe ecaleni kwe-clavicle kwi-fossa engaphantsi kwayo, ibonisa i-short-axis view, kwaye i-probe ihamba ngokucothayo ezantsi embindini;ngokobuchwepheshe, i-axillary vein igqojozwe apha;vula i-probe i-90 degrees ukubonisa i-long-axis view ye-blood vessel, i-probe iyancipha kancane ukuya entloko;emva kokuba i-probe izinzile, inaliti ihlatywa ukusuka kumbindi wecala le-probe, kwaye inaliti ifakwe phantsi kwesikhokelo se-ultrasound yexesha langempela.
d) Kutshanje, i-microconvex ipuncture encinci ene-frequency esezantsi kancinane isetyenzisiwe ukukhokela, kwaye iprobe incinci kwaye ingabona nzulu.
5. I-Femoral vein catheterization
a) Izinto eziluncedo: Gcina kude nesixhobo sokuphefumla kunye nezixhobo zokubeka iliso, akukho mngcipheko wepneumothorax kunye ne-hemothorax
b) Akukho luncwadi oluninzi malunga ne-ultrasound-guided puncture.Abanye abantu bacinga ukuba kuthembeke kakhulu ukugqobhoza umphezulu womzimba ngeziphawuli ezicacileyo, kodwa i-ultrasound ayisebenzi kakuhle.Isikhokelo se-Ultrasound sifanelekile kakhulu kwi-FV ye-anatomical variation kunye nokubanjwa kwentliziyo.
c) Ukuma komlenze wesele kunciphisa ukudibana komphezulu we-FV kunye ne-FA, iphakamisa intloko kwaye yandise imilenze ngaphandle ukuze yandise i-lumen ye-venous.
d) Ubuchwephesha buyafana nobokugqobhoza kwe-jugular yangaphakathi
I-Cardiac ultrasound isikhokelo sokubeka ucingo
1. I-TEE cardiac ultrasound ineyona ndawo ichanekileyo yokubeka ingcebiso, kodwa iyonzakala kwaye ayinakusetyenziswa rhoqo.
2. Indlela yokuphucula uthelekiso: sebenzisa i-microbubbles kwi-saline eshukumayo eqhelekileyo njenge-agent echaseneyo, kwaye ungene kwi-atrium yasekunene kwimizuzwana emi-2 emva kokuphuma kwe-laminar kwincam yecatheter.
3. Ifuna amava abanzi kwi-cardiac ultrasound scanning, kodwa inokuqinisekiswa ngexesha lokwenyani, inomtsalane.
I-Lung ultrasound scan yokulawula i-pneumothorax
1. I-Ultrasound-guided central venous puncture ayinciphisi kuphela iziganeko ze-pneumothorax, kodwa iphinde ibe novakalelo oluphezulu kunye neenkcukacha ezithile zokufumanisa i-pneumothorax (ephezulu kune-X-ray yesifuba)
2. Kucetyiswa ukuba udibanise kwinkqubo yokuqinisekisa emva kokuhlinzwa, enokuthi ikhangele ngokukhawuleza nangokuchanekileyo kwindawo yokulala.Ukuba idibaniswe necandelo langaphambili le-ultrasound ye-cardiac, kulindeleke ukuba inciphise ixesha lokulinda lokusetyenziswa kwe-catheter.
3. Lung ultrasound: (ingcaciso eyongezelelweyo yangaphandle, ireferensi kuphela)
Umfanekiso wemiphunga eqhelekileyo:
Umgca A: Umgca we-pleural hyperechoic otyibilika ngokuphefumla, ulandelwa yimigca emininzi enxuseneyo nawo, i-equidistant, kwaye icuthelwe ngobunzulu, oko kukuthi, ukutyibilika kwemiphunga.
I-M-ultrasound ibonise ukuba umgca we-hyperechoic obuyela kwi-probe ngokuphefumla wawufana nolwandle, kwaye umgca we-pectoral mold wawufana nesanti, oko kukuthi, uphawu lolwandle.
Kwabanye abantu abaqhelekileyo, indawo yokugqibela ye-intercostal ngaphezu kwe-diaphragm inokubona ngaphantsi kwe-3 ye-laser-efana nemifanekiso efana ne-laser evela kumgca we-pectoral mold, isuka ngokuthe nkqo ezantsi kwesikrini, kunye nokuphindaphinda ngokuphefumla-umgca we-B.
Umfanekiso wePneumothorax:
Umgca B uyanyamalala, i-lung sliding iyanyamalala, kwaye uphawu lolwandle lutshintshwa luphawu lwebhakhowudi.Ukongeza, uphawu lwendawo yemiphunga lusetyenziselwa ukumisela ubungakanani be-pneumothorax, kwaye indawo yemiphunga ibonakala apho uphawu lolwandle kunye nebhakhowudi yebhakhowudi ibonakala ngokutshintshanayo.
Uqeqesho lweCVC olukhokelwa yi-Ultrasound
1. Ukunqongophala kwemvumelwano ngoqeqesho kunye nemigangatho yoqinisekiso
2. Imbono yokuba iindlela zokufaka iimfama zilahlekile ekufundeni iindlela ze-ultrasound zikhona;nangona kunjalo, njengoko ubuchule be-ultrasound busasazeka, ukhetho phakathi kokhuseleko lwesigulane kunye nokugcinwa kweendlela ezinokuthi zingabikho ukusetyenziswa kufuneka zithathelwe ingqalelo.
3. Uvavanyo lobuchule beklinikhi kufuneka lunikwe amanqaku ngokujonga umsebenzi weklinikhi kunokuxhomekeka kwinani leenkqubo.
ukuququmbela
Isitshixo kwi-CVC ekhokelwa yi-ultrasound esebenzayo kunye nekhuselekileyo kukuqonda imigibe kunye nokulinganiselwa kolu buchule ngaphezu koqeqesho olufanelekileyo.
Ixesha lokuposa: Nov-26-2022
