Медицинская литература. Новинки

 

 

 

 

 

 

Кава-катетеризация через наружную яремную вену как метод первого ряда при осуществлении центрального венозного доступа

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Цель исследования. Разработка и оценка нового, более безопасного алгоритма катетеризации верхней полой вены. Материал и методы. Одним манипулятором в течение 2009 г. были выполнены 194 катетеризации центральных вен 174 пациентам отделения реанимации многопрофильной больницы. У всех больных катетеризация наружной яремной вены рассматривалась в качестве метода первого ряда. При невозможности ее пункции или проведения катетера в магистральный кровоток выполнялась попытка катетеризация внутренней и, далее, подключичной вен. Результаты. Предложены подходы, облегчающие проведение катетера через клапаны и изгиб в терминальной части наружной яремной вены, а также позволяющие избежать глубокого или поверхностного позиционирования конца катетера при различных методах центрального венозного доступа. Идеальная эффективность катетеризации наружной яремной вены составила 85,3%, реальная эффективность – 51%. Вывод. Внедрение описанного алгоритма позволит вдвое сократить частоту тяжелых осложнений кава-катетеризации.

Ключевые слова:
катетеризация центральной вены, алгоритм.

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Cava catheterization through the external jugular vein as first-line method in the implementation of central venous access

Objective. Development and evaluation of a safer algorithm for cava-catheterization. Patients and methods. One manipulator during 2009 carried out 194 central venous catheterizations in 174 patients of ICU in a multi-specialty hospital. In all patients external jugular catheterization with intrathoracic positioning of catheter tip was considered a first line method; if impossible, internal jugular and, further, subclavian routes were attempted. Results. We described approaches facilitating passage of a catheter through valves and bends in the terminal part of external jugular vein, and also warranting from either superficial or deep catheter insertion while utilizing various methods of vascular access. Efficacy of external jugular catheterization exceeds 85.3%, effectiveness – 51%. Conclusion. Implementation of the described algorithm allows cutting in half incidence of serious complications associated with cava-catheterization.

Keywords:
сatheterization, сentral venous, аlgorithms.