RU2471516C1 - Method for catheterisation of inner jugular vein from central approach under ultrasonic navigation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly anaesthesiology and resuscitation. With aided longitudinal ultrasound scanning, a vein is punctured with a needle. The needle is placed in a caudal direction in a point 1-1.5 cm below an apex of a triangle at 15° to skin surface. The triangle is formed by feet of thoracoclaviculomastoid muscle. A J-conductor attached to the needle is moved into a vein lumen immediately after wall puncture.

EFFECT: method enables reducing a risk of developing complications, providing higher safety ensured by needle visualisation during catheterisation, and rate thereby avoiding an aspiration test.

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Description

The present invention relates to medicine, in particular to anesthesiology and intensive care, and can be used for catheterization of the internal jugular vein from a central access under continuous ultrasound scanning.

As a prototype, the method of catheterization of the internal jugular vein by central access under dynamic ultrasound navigation was selected, including transverse ultrasound scanning technique, puncture of a vein at the apex of the triangle between the sternocleidomastoid muscle legs with a puncture needle directed at an angle of 35-45 ° to the body surface, performing an aspiration test after ultrasound imaging of the needle in the lumen of the vein, the installation of a J-shaped conductor and then a catheter (see Bykov M.V. Ultrasound examinations to ensure infusion therapy in the department ryah resuscitation and intensive care Tver: LLC "Publishing house" Triada ", 2011. - p.7-12).

However, the operator’s attention to the screen of the ultrasound monitor, and not to the puncture area, leads to the migration of the needle and does not ensure its clear fixation during the aspiration test and the establishment of the J-shaped conductor, which increases the risk of penetration into the paravasal tissue or exit of the lumen of the needle from a vein, or perforation of its posterior wall. Emerging technical difficulties increase the risk of failed vein catheterization and the development of complications (pneumothorax, artery puncture, hematoma formation). Performing an aspiration test lengthens the time of the procedure and requires the participation of an assistant. In addition, with transverse ultrasound scanning, it is possible to visualize only a fragment of the needle, which may not coincide with the true location of its end, which is dangerous by installing a catheter paravasally.

The objective of the invention is the improvement of the method.

The technical result is to reduce the risk of complications in the case of migration of the end of the needle, as well as improper installation of the catheter in the internal jugular vein, increasing safety, speed and quality of manipulation.

The technical result is achieved by the fact that in the method, including the puncture of a vein under ultrasound control, the puncture of the internal jugular vein is performed under a longitudinal ultrasound scan at a point 1-1.5 cm below the top of the triangle formed by the legs of the sternocleidomastoid muscle with a needle set at an angle of 15 ° to the surface of the skin with a J-shaped conductor connected to it, which is advanced into the lumen of the vein immediately after a puncture of its wall.

The method is as follows:

The patient is placed in the Trendelenburg position, a roller is placed under the shoulder blades. After processing the surgical field with an antiseptic solution, an ultrasound “club-shaped” sensor with a short surface is installed in the projection of the internal jugular vein longitudinally to its location. Before starting the puncture, a case with a J-shaped conductor is connected to the needle. After visualizing the veins on the screen of the ultrasound monitor, the skin is punctured with a needle installed in the caudal direction at a point 1-1.5 cm below the top of the triangle formed by the legs of the sternocleidomastoid muscle at an angle of 15 ° to the skin surface. Under constant longitudinal ultrasound control, the needle is advanced to the front wall of the internal jugular vein and is punctured. After visualizing the needle in the lumen of the vein, a J-shaped conductor is immediately inserted. The needle is removed, and a catheter is inserted into the vein through a conductor.

Clinical example

Patient K., IB No. 254914. Age 47 years old. Weight 112 kg. Diagnosis: unstable uncomplicated fracture of the Th7-Th8 vertebrae. Operation: transpedicular fixation of Th6-Th9, decompression of the spinal cord, shortening osteotomy of Th7-Th8 vertebrae. Estimated blood loss during and after surgery is 1,500 ml. The anatomical feature of the patient was a short neck. The patient is laid on a table in the Trendelenburg position with an angle of inclination of 15 °. The surgical field is treated with 70% ethyl alcohol. An ultrasound scan of the neck vessels to the right was performed using a Micromax (Sonosite) apparatus with a “club-shaped” HST 5-10 sensor. The position of the internal jugular vein, which was located lateral to the common carotid artery, was determined at a depth of 3.2 cm. A case with a J-shaped conductor was connected to the needle connector. The skin puncture was performed with a needle at a point 1 cm below the top of the triangle between the legs of the sternocleidomastoid muscle at an angle of 15 ° to the body surface. After visualizing the moment of puncture of the vessel, a conductor was inserted into its lumen, the needle was removed, a catheter was inserted into the vein along the conductor. The catheter is fixed to the skin. The whole procedure is performed under continuous ultrasound control without the assistance of an assistant. No catheterization complications were noted.

A method for catheterization of the internal jugular vein by central access under ultrasound navigation reduces the risk of complications. Continuous visualization of the position of the needle allows you to refuse to perform an aspiration test, which increases the reliability of the method, since it eliminates the possibility of needle migration during manipulations with the syringe and the conductor case. Using a “club-shaped” sensor with a short surface allows you to always perform a longitudinal ultrasound scan technique, which provides a detailed visualization of surface structures and needles throughout its length. The method reduces the execution time of the manipulation, the number of failed attempts to catheterize the internal jugular vein.

Claims (1)

The method of catheterization of the internal jugular vein by central access under ultrasound navigation, consisting of a puncture of the vein under ultrasound control, characterized in that the puncture of the internal jugular vein is performed under a longitudinal ultrasound scan at a point 1-1.5 cm below the top of the triangle formed by the legs of the sternocleidomastoid muscle , a needle mounted at an angle of 15 ° to the surface of the skin with a J-shaped conductor connected to it, which is advanced into the lumen of the vein immediately after a puncture of its wall.