Safety and efficacy of ultrasound assistance-2008

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Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants
神经外科婴儿超声引导下颈内静脉置管的安全和效果研究
M. Lamperti
D. Caldiroli
P. Cortellazzi
D. Vailati
A. Pedicelli
F. Tosi
M. Piastra
D. Pietrini

Abstract Objective: Ultrasound guidance (USG) for internal jugular cannulation is the best solution in difficult settings where  paediatric patients are involved. This is an outcome study on efficacy and complications of the USG for the internal jugular vein (IJV) cannulation in neurosurgical infants as well as an ultrasound study of anatomical findings of the IJVs in infants. Design
and settings: A prospective study conducted in two Academic Neurosurgical hospitals. Participants: In 191 babies (body weight\15 kg), anatomical findings were studied. We performed CVC echo guided placement in 135/191 infants (weighting
\10 kg). Results: After a brief training period, both institutions adopted a common protocol and USG device. We obtained successful cannulation in all patients. Carotid puncture (1.5%) was the only main complication registered and minor
complications were poor. Time required for cannulation was 12.5 ± 5.7 min. Anatomical findings (in 191 patients) were IJV laterality in 34.6% cases, IJV antero-lateral in 59.7% and anterior in 5.7%. A linear relation was found between weight
and internal jugular vein diameter even if R2 = 0.43 and the model cannot be used to predict the exact size of the vein. In 62/135 babies weighting\10 kg, anatomical measurements were done in supine and Trendelemburg position. Trendelemburg
position increases significantly (P\0.001) IJV diameter, but not IJV depth. Conclusions: We considered ultrasound guidance as the first choice in infants because it can enhance IJV cannulation success, safety, and allows one to measure relationships
and diameter of the IJV and optimise the central line positioning.
Keywords: Pediatrics Cardiovascular monitoring
Peri-operative care

Intensive Care Med (2008) 34:2100–2105
DOI 10.1007/s00134-008-1210-9

这篇文章的特别之处是文后还附有图片，以说明颈内静脉的解剖位置，这对于我们今后发表用文字表述总嫌不足的相关研究成果非常有借鉴意义。