Umlando wokufinyelela kwe-venous emaphakathi
1. 1929: Udokotela ohlinzayo ongumJalimane u-Werner Forssmann wafaka ipayipi lokuchama elisuka emthanjeni oyi-cubital ongaphambili kwesokunxele, futhi waqinisekisa nge-X-ray ukuthi i-catheter yangena ku-atrium engakwesokudla.
2. 1950: I-Central venous catheter ikhiqizwa ngobuningi njengendlela entsha yokufinyelela okuphakathi.
3. 1952: I-Aubaniac ehlongozwayo yokubhoboza i-subclavian vein, uWilson wabe esehlongozela i-CVC catheterization ngokusekelwe kumthambo we-subclavian.
4. 1953: U-Sven-Ivar Seldinger uhlongoze ukuthi esikhundleni senaliti eqinile afake i-catheter yomhlahlandlela wensimbi yomhlahlandlela we-peripheral venipuncture, futhi inqubo ye-Seldinger yaba ubuchwepheshe obushintshashintshayo bokubekwa kwe-venous catheter emaphakathi.
5. 1956: UForssmann, uCournand, uRichards wawina uMklomelo KaNobel Kwezokwelapha ngeqhaza labo ekwenziweni kwe-catheterization yenhliziyo.
6. 1968: Umbiko wokuqala ngesiNgisi wokufinyelela kwe-venous ye-jugular yangaphakathi yokuqapha ingcindezi ye-venous emaphakathi
7. 1970: Umqondo we-tunnel catheter wahlongozwa okokuqala
8. 1978: Indawo ye-Venous Doppler yokumaka indawo yangaphakathi yomzimba we-jugular
9. 1982: Ukusetshenziswa kwe-ultrasound ukuqondisa ukufinyelela kwe-venous ephakathi kwabikwa okokuqala nguPeters et al.
10. 1987: U-Wernecke et al uqale wabika ukusetshenziswa kwe-ultrasound ukuthola i-pneumothorax
11. 2001: I-Bureau of Health Research and Quality Evidence Reporting ibala i-venous access point-of-care ultrasound njengenye yezinqubo ezingu-11 ezifanele ukukhushulwa kabanzi.
12. 2008: I-American College of Emergency Physicians ibala ukufinyelela okuphakathi kwe-venous okuqondiswa yi-ultrasound njengokuthi "uhlelo lokusebenza lwe-ultrasound oluphuthumayo oluyisisekelo"
13.2017: U-Amir et al uphakamisa ukuthi i-ultrasound ingasetshenziswa ukuqinisekisa indawo ye-CVC futhi ingabandakanyi i-pneumothorax ukuze konge isikhathi nokuqinisekisa ukunemba
Incazelo yokungena kwe-venous emaphakathi
1. I-CVC ngokuvamile ibhekisela ekufakweni kwe-catheter emthanjeni omaphakathi ngomthambo we-jugular wangaphakathi, i-subclavian vein kanye ne-femoral vein, ngokuvamile ichopho le-catheter litholakala ku-high vena cava, i-vena cava engaphansi, i-caval-atrial junction, i-atrium yangakwesokudla noma i-brachiocephalic vein, phakathi kwayo i-vena cava ephakeme.Kukhethwa ukuhlangana kwe-venous noma i-cavity-atrial
2. Ikhethethara ye-venous efakwe ngokuzungezile i-PICC
3. Ukufinyelela kwe-venous emaphakathi kusetshenziswa kakhulu:
a) Umjovo ogxilile we-vasopressin, inositol, njll.
b) Ama-catheter abhobozayo amakhulu ukuze afakwe uketshezi lokuvuselela kanye nemikhiqizo yegazi
c) I-catheter enkulu yokubhoboza yokwelapha izinso noma i-plasma exchange therapy
d) Ukuphathwa komsoco kwabazali
e) Ukwelashwa kwemithi elwa namagciwane isikhathi eside noma i-chemotherapy
f) I-catheter yokupholisa
g) Amashethi noma ama-catheter eminye imigqa, njengama- pulmonary artery catheter, izintambo ezihambayo kanye nezinqubo ze-endovascular noma izinqubo zokungenelela kwenhliziyo, njll.
Izimiso eziyisisekelo zokubeka i-CVC eqondiswa yi-ultrasound
1. Ukuqagela kokukhanselwa kwe-CVC yendabuko okusekelwe ezimpawu zomhlaba ze-anatomical: okulindelekile kwe-vascular anatomy kanye ne-patency yemithambo
2. Izimiso ze-Ultrasound Guidance
a) Ukuhluka kwe-anatomical: indawo yemithambo, izimpawu ze-anatomical zangaphandle komzimba ngokwazo;I-ultrasound ivumela ukubuka ngeso kwesikhathi sangempela nokuhlolwa kwemikhumbi kanye ne-anatomy eseduze
b) I-Vascular Patency: I-Ultrasonography yangaphambi kokuhlinzwa ingathola i-thrombosis kanye ne-stenosis ngesikhathi (ikakhulukazi ezigulini ezigula kakhulu ezinezigameko eziphezulu ze-deep vein thrombosis)
c) Ukuqinisekisa ukuma kwethiphu ye-vein kanye ne-catheter: ukubonwa kwesikhathi sangempela kokungena kwe-guidewire emthanjeni, i-brachiocephalic vein, i-vena cava engaphansi, i-atrium yangakwesokudla noma i-vena cava ephakeme.
d) Izinkinga ezincishisiwe: i-thrombosis, i-tamponade yenhliziyo, ukubhoboza kwe-arterial, i-hemothorax, i-pneumothorax
Ukukhethwa kwe-Probe kanye Nezisetshenziswa
1. Izici zemishini: Isithombe se-2D siyisisekelo, i-Doppler yombala kanye ne-pulsed Doppler ingakwazi ukuhlukanisa phakathi kwemithambo nemithambo, ukuphathwa kwerekhodi lezokwelapha njengengxenye yamarekhodi ezokwelapha esiguli, ikhava yokuhlola oyinyumba/isigqebhezana siqinisekisa ukuhlukaniswa okungenanyumba.
2. Ukukhetha uphenyo:
a) Ukungena: Imithambo yangaphakathi ye-jugular neyesifazane ivamise ukushona ngo-1-4 cm ngaphansi kwesikhumba, kanti i-subclavia vein idinga u-4-7 cm.
b) isixazululo esifanele kanye nokugxila okungalungiseka
c) I-probe yosayizi omncane: 2 ~ 4cm ububanzi, kulula ukubona izimbazo ezinde nezifushane zemithambo yegazi, ukubeka kalula uphenyo kanye nenaliti
d) 7~12MHz umugqa omncane omncane uvame ukusetshenziswa;i-convex encane ngaphansi kwe-clavicle, i-hockey stick probe yezingane
Indlela ye-eksisi emfushane kanye nendlela ye-eksisi ende
Ubudlelwano phakathi kwe-probe nenaliti bunquma ukuthi ingaphakathi kwendiza noma ingaphandle kwendiza
1. Ithiphu yenaliti ayinakubonwa ngesikhathi sokusebenza, futhi indawo yethiphu yenaliti idinga ukunqunywa ngokushwiba i-probe;izinzuzo: ijika lokufunda elifushane, ukubonwa okungcono kwezicubu ze-perivascular, nokubekwa kalula kwe-probe kubantu abakhuluphele kanye nezintamo ezimfushane;
2. Umzimba wenaliti ophelele kanye nethiphu yenaliti kungabonakala ngesikhathi sokuhlinzwa;kuyinselele ukugcina imithambo yegazi nezinaliti endizeni yezithombe ze-ultrasound ngaso sonke isikhathi
static futhi ashukumisayo
1. Indlela ye-Static, i-ultrasound isetshenziselwa kuphela ukuhlolwa kwangaphambili nokukhethwa kwamaphuzu okufaka inaliti
2. Indlela enamandla: ukubhoboza okuqondiswa yi-ultrasound ngesikhathi sangempela
3. Indlela yokumaka ebusweni bomzimba <indlela emile <indlela eguquguqukayo
Ukubhoboza kwe-CVC eqondiswa yi-Ultrasound kanye ne-catheterization
1. Ukulungiselela ngaphambi kokuhlinzwa
a) Ukubhaliswa kolwazi lwesiguli ukuze kugcinwe amarekhodi eshadi
b) Skena indawo ezobhobozwa ukuze uqinisekise i-vascular anatomy kanye ne-patency, futhi unqume uhlelo lokuhlinza.
c) Lungisa ukuzuza kwesithombe, ukujula, njll. ukuze uthole isimo esihle kakhulu sesithombe
d) Beka okokusebenza kwe-ultrasound ukuqinisekisa ukuthi indawo yokubhoboza, i-probe, isikrini kanye nomugqa wokubona kuyi-collinear
2. Amakhono okusebenza
a) I-saline ye-physiological isetshenziswa endaweni yesikhumba esikhundleni se-couplant ukuvimbela i-couplant ukuthi ingangeni emzimbeni womuntu.
b) Isandla esingalawuleki sibamba i-probe kancane futhi sincike kancane esigulini ukuze sizinze
c) Gcina amehlo akho ethe njo esikrinini se-ultrasound, futhi uzwe izinguquko zengcindezi zithunyelwa ngenaliti ngezandla zakho (umuzwa wokwehluleka)
d) Ukwethulwa kocingo oluqondisayo: Umbhali uncoma ukuthi okungenani ama-5 cm wocingo oluqondisayo lubekwe emkhunjini we-venous ophakathi (okungukuthi, ucingo oluqondisayo kufanele lube okungenani amasentimitha ayi-15 ukusuka esihlalweni senaliti);Udinga ukungena ku-20 ~ 30cm, kodwa ucingo oluqondisayo lungena lujule, kulula ukubangela i-arrhythmia
e) Ukuqinisekiswa kokuma kwentambo yomhlahlandlela: Skena nge-eksisi emfushane bese kuba yi-eksisi ende yomkhumbi wegazi ukusuka ekugcineni okude, bese ulandelela ukuma kwentambo yomhlahlandlela.Isibonelo, lapho i-jugular vein yangaphakathi ibhobozwa, kuyadingeka ukuqinisekisa ukuthi ucingo lomhlahlandlela lungena emthanjeni we-brachiocephalic.
f) Yenza i-scalpel encane nge-scalpel ngaphambi kokuvuleka, i-dilator idlula kuwo wonke amathishu phambi komthambo wegazi, kodwa gwema ukubhoboza imithambo yegazi.
3. I-Internal Jugular Vein Cannulation Trap
a) Ubudlelwano phakathi komthambo we-carotid kanye nomthambo we-jugular wangaphakathi: Ngokwe-anatomically, umthambo we-jugular wangaphakathi ngokuvamile utholakala ngaphandle komthambo.Ngesikhathi sokuskena kwe-axis emfushane, ngenxa yokuthi intamo iyindilinga, ukuskena ezindaweni ezihlukene kwenza ama-engeli ahlukene, futhi kungenzeka imithambo egqagqene kanye nemithambo yegazi.Isimanga.
b) Ukukhethwa kwendawo yokungena yenaliti: ububanzi beshubhu eseduze bukhulu, kodwa buseduze nephaphu, futhi ingozi ye-pneumothorax iphezulu;Kunconywa ukuskena ukuze uqinisekise ukuthi umkhumbi wegazi endaweni yokungena yenaliti ukujula ngo-1 ~ 2cm ukusuka esikhumbeni.
c) Skena wonke umthambo we-jugular wangaphakathi kusengaphambili, hlola i-anatomy kanye ne-patency yomkhumbi wegazi, gwema i-thrombus kanye ne-stenosis endaweni yokubhoboza futhi uyihlukanise nomthambo we-carotid.
d) Gwema ukubhoboza komthambo we-carotid: Ngaphambi kwe-vasodilation, indawo yokubhoboza nendawo yocingo oluqondisayo kudingeka kuqinisekiswe ekubukweni kwe-eksisi ende nefushane.Ngenxa yezizathu zokuphepha, isithombe se-eksisi eside socingo oluqondisayo sidinga ukubonakala emthanjeni we-brachiocephalic.
e) Ukuphendula ikhanda: Indlela yendabuko yokumaka i-puncture incoma ukuphendulela ikhanda ukuze kugqanyiswe ukumaka kwemisipha ye-sternocleidomastoid nokuveza kanye nokulungisa umthambo we-jugular wangaphakathi, kodwa ukuphendulela ikhanda ngama-degree angu-30 kungase kubangele umthambo we-jugular wangaphakathi kanye nomthambo we-carotid ukunqwabelana okungaphezu kwalokho. 54%, futhi ukubhoboza okuqondiswa yi-ultrasound akunakwenzeka.Kunconywa ukujika
4.I-Subclavian vein catheterization
a) Kufanele kuqashelwe ukuthi ukuskena kwe-ultrasound kwe-subclavia vein kunzima ngandlela-thile
b) Izinzuzo: Indawo ye-anatomical yomthambo inokwethenjelwa, elungele ukubhobozwa kwendiza
c) Amakhono: I-probe ibekwe eduze kwe-clavicle ku-fossa engezansi kwayo, ikhombisa ukubuka kwe-axis emfushane, futhi i-probe ihamba kancane kancane phakathi nendawo;ngokobuchwepheshe, i-axillary vein ibhoboziwe lapha;vula i-probe ngama-degree angu-90 ukukhombisa umbono we-axis ende yomkhumbi wegazi, uphenyo lutshekele kancane ngasekhanda;ngemva kokuba i-probe isizinzile, inaliti ibhobozwa phakathi nendawo yohlangothi lwe-probe, futhi inaliti ifakwa ngaphansi kokuqondisa kwe-ultrasound yesikhathi sangempela.
d) Muva nje, ukubhoboza okuncane kwe-microconvex okune-frequency ephansi kusetshenziswe ukuqondisa, futhi uphenyo luncane futhi luyakwazi ukubona ukujula.
5. I-Catheterization ye-Femoral vein
a) Izinzuzo: Gcina kude nepheshana lokuphefumula kanye nemishini yokuqapha, akukho bungozi be-pneumothorax ne-hemothorax
b) Azikho izincwadi eziningi zokubhoboza okuqondiswa yi-ultrasound.Abanye abantu bacabanga ukuthi kuthembeke kakhulu ukubhoboza ubuso bomzimba ngezimpawu ezisobala, kodwa i-ultrasound ayisebenzi kahle.Ukuqondisa kwe-Ultrasound kulungele kakhulu ukuhlukahluka kwe-FV anatomical kanye nokuboshwa kwenhliziyo.
c) Ukuma komlenze wexoxo kunciphisa ukugqagqana kwengaphezulu kwe-FV ne-FA, kuphakamise ikhanda futhi kunwebe imilenze ngaphandle ukuze kunwebe ilume ye-venous.
d) Indlela yokusebenza iyafana neyokubhoboza umthambo we-jugular wangaphakathi
Cardiac ultrasound guide wire positioning
1. I-TEE ultrasound yenhliziyo inokuma kwethiphu enembe kakhulu, kodwa iyalimaza futhi ayikwazi ukusetshenziswa njalo.
2. Indlela yokuthuthukisa ukugqama: sebenzisa amabhamuza ku-saline evamile enyakazayo njenge-ejenti ehlukile, bese ufaka i-atrium engakwesokudla phakathi nemizuzwana emi-2 ngemva kokukhipha ukugeleza kwe-laminar kwithiphu ye-catheter.
3. Idinga isipiliyoni esibanzi ekuskeneni kwe-cardiac ultrasound, kodwa ingaqinisekiswa ngesikhathi sangempela, ekhangayo
I-ultrasound yamaphaphu ukukhipha i-pneumothorax
1. I-Ultrasound-guided central vous puncture ayinciphisi nje kuphela ukwenzeka kwe-pneumothorax, kodwa futhi inokuzwela okuphezulu nokucaciswa kokutholwa kwe-pneumothorax (iphezulu kune-X-ray yesifuba)
2. Kunconywa ukuthi uyihlanganise nenqubo yokuqinisekisa emva kokuhlinzwa, engakwazi ukuhlola ngokushesha futhi ngokunembile eceleni kombhede.Uma ihlanganiswe nesigaba sangaphambilini se-ultrasound yenhliziyo, kulindeleke ukuthi ifinyeze isikhathi sokulinda sokusetshenziswa kwe-catheter.
3. I-Lung ultrasound: (ulwazi lwangaphandle olwengeziwe, ukuze kusetshenziswe inkomba kuphela)
Isithombe samaphaphu esivamile:
Umugqa A: Umugqa we-pleural hyperechoic oslayida ngokuphefumula, ulandelwa imigqa eminingi ehambisana nawo, i-equidistant, futhi incishiswe nokujula, okungukuthi, ukushelela kwamaphaphu.
I-M-ultrasound ibonise ukuthi umugqa we-hyperechoic obuyela ohlangothini lwe-probe ngokuphefumula wawufana nolwandle, futhi umugqa we-pectoral mold wawufana nesihlabathi, okungukuthi, uphawu lolwandle.
Kwabanye abantu abavamile, indawo yokugcina ye-intercostal ngaphezu kwe-diaphragm ingakwazi ukubona izithombe ezinjenge-laser ezingaphansi kuka-3 ezivela emugqeni wesikhunta se-pectoral, zinwebeka ziqonde phansi kwesikrini, futhi ziphindaphindeka ngokuphefumula—umugqa B.
Isithombe se-Pneumothorax:
Umugqa B uyanyamalala, ukushelela kwamaphaphu kuyanyamalala, futhi uphawu lolwandle luthathelwa indawo uphawu lwebhakhodi.Ukwengeza, uphawu lwephoyinti lamaphaphu lusetshenziselwa ukunquma izinga le-pneumothorax, futhi indawo yamaphaphu ibonakala lapho uphawu lolwandle kanye nophawu lwebhakhodi kuvela ngokushintshana.
Ukuqeqeshwa kwe-CVC okuqondiswa yi-Ultrasound
1. Ukungabi khona kokuvumelana ngamazinga okuqeqesha kanye nezitifiketi
2. Umbono wokuthi amasu okufaka impumputhe alahlekile ekufundeni amasu e-ultrasound akhona;Nokho, njengoba amasu e-ultrasound asakazeka kakhulu, ukukhetha phakathi kokuphepha kwesiguli nokugcinwa kwamasu okungenzeka mancane amathuba okuba asetshenziswe kufanele kucatshangelwe.
3. Ukuhlolwa kwekhono lomtholampilo kufanele kutholwe ngokubheka umkhuba womtholampilo kunokuncika enanini lezinqubo
Ekuphetheni
Isihluthulelo se-CVC eqondiswa yi-ultrasound ephumelelayo nephephile ukuqaphela izingibe kanye nemikhawulo yale nqubo ngaphezu kokuqeqeshwa okufanele.
Isikhathi sokuthumela: Nov-26-2022
