RU2550937C1 - Method of installing dual-lumen catheter for performing haemodialysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: puncture of jugular vein in realised under ultrasound control. Constant ultrasound control of dual-lumen catheter is realised in the process of its passing in internal jugular vein, right atrium. Location of end part of catheter in cavity of right atrium is controlled. After installation of catheter through arterial and venous ports blood is sampled by syringe in volume 50 ml. If syringe is filled completely faster than for 10 seconds, it testifies to correct installation of the catheter.

EFFECT: creation of adequate vascular access for carrying out haemodialysis procedure with simultaneous minimisation of complications due to constant control of catheter location and adequate blood sampling during haemodialysis.

2 dwg, 1 ex

Description

The proposed method relates to medicine, namely to nephrology, and can be used to install a double-lumen catheter for hemodialysis.

There is a method of catheterization of the external jugular vein for hemodialysis, in which the external jugular vein is ligated, a catheter is inserted into the vein towards the superior vena cava and the right atrium, after the catheter is inserted into the vein, its position is verified by x-ray (Surgery. Journal of N. N. I. Pirogov, No. 11, 2005, S. 47-50).

The disadvantage of this method is the open method of installing the catheter into the jugular vein, the lack of dynamic control over the introduction and advancement of the catheter through the jugular vein, which can lead to injury and puncture of the vein. The disadvantage of this method is that the correctness of the installation of the catheter is carried out only after the operation using the x-ray method, which increases the radiation load on the patient.

Closest to the proposed is a method for catheterization of the internal jugular vein by central access under ultrasound navigation, in which a needle is punctured under continuous longitudinal ultrasound scanning. At the same time, it is set in the caudal direction at a point 1-1.5 cm below the top of the triangle at an angle of 15 ° to the skin surface. In this case, the triangle is formed by the legs of the sternocleidomastoid muscle. A J-shaped conductor connected to the needle is advanced into the lumen of the vein immediately after a puncture of its wall. The method makes it possible to reduce the risk of complications, increase safety due to visualization of the needle during catheterization and speed due to the fact that the aspiration test is not performed (RF Patent No. 2471516, A61M 25/095, 01/10/2013).

The disadvantage of this method is that the process of conducting the catheter through the jugular vein is not controlled and therefore, with the peculiarities of the anatomical structure of the venous channel, the catheter can be inserted incorrectly into the homo- and contralateral subclavian vein. Another disadvantage of this method is that the installation site of the end of the catheter is not controlled, which can lead to perforation of the tricuspid valve, the wall of the right atrium, the catheter into the right ventricle, which threatens the development of cardiac arrhythmias, as well as the bend of the end section of the catheter.

The objective of the proposed method is to minimize complications and create adequate vascular access for the hemodialysis procedure.

The task is carried out due to the fact that they additionally carry out constant ultrasonic monitoring of the position of the double-lumen catheter during its passage through the internal jugular vein, right atrium, control of the location of the end section of the catheter in the cavity of the right atrium and blood sampling after the catheter is inserted through the arterial and venous ports for assessing the adequacy of the volume of blood taken for hemodialysis.

The proposed method is as follows: the patient is placed in a position so that the head end of the operating table is below the level of the pelvis. After this, an ultrasound examination of the vessels of the neck is performed to determine the features of the location and architectonics of the internal jugular vein. The surgical field is treated with an antiseptic. An ultrasound probe is installed longitudinally to its location above the internal jugular vein in the projection of the proposed puncture, and the internal jugular vein is visualized. After this, the jugular vein is punctured with a needle, after visualizing the needle, a conductor is inserted into the lumen of the vein. A double-lumen catheter is inserted through the conductor into the internal jugular vein. The whole process of conducting a catheter through the internal jugular vein is carried out under constant ultrasound monitoring. In addition, under constant ultrasonic monitoring, the location of the end section of the catheter is determined, which avoids bending of the end section of the catheter, minimizing the risk of perforation of the tricuspid valve or wall of the right atrium, and conducting a catheter into the right ventricle. After the final installation of a double-lumen catheter through a venous and arterial ports, a 50 ml blood is taken with a syringe. If the syringe is filled completely faster than in 10 seconds, then this indicates that in a minute blood sampling will be at least 300 ml, which allows to achieve adequate blood sampling during the hemodialysis procedure. After the catheter is inserted, the patient is connected through it to the hemodialysis apparatus.

All of the above eliminates the entry of a catheter into the subclavian vein, allows you to control the formation of blood clots in the internal jugular vein and right atrium, creates the conditions for the correct installation of the end section of the catheter, as well as minimizing the risk of complications: internal jugular vein thrombosis, perforation of the tricuspid valve, right atrial wall, conducting catheter into the right ventricle, which threatens the development of cardiac arrhythmias. Filling a syringe with blood from venous and arterial ports for a certain period of time immediately after the catheter is installed allows you to evaluate the adequacy of blood sampling for the hemodialysis procedure and, if there is no catheter under ultrasound control, change the position of the catheter.

Comparison of the claimed technical solution with the prototype allows us to establish compliance with its criterion of "novelty."

In the study of other technical solutions in this field, the features that distinguish the claimed invention from the prototype were not identified, and therefore they provide the claimed solution with the criterion of "inventive step".

Example 1. A patient with acute tubulointerstitial nephritis complicated by acute renal failure was admitted for treatment to a hospital. Given the clinical picture and the high level of creatinine, urea, potassium, an emergency hemodialysis session is indicated. In order to create vascular access for a hemodialysis session, the installation of a double-lumen catheter into the internal jugular vein on the right is shown. The patient is transported to the operating room, placed in a position so that the head end is below the level of the pelvis. After this, an ultrasound examination of the vessels of the neck on the right was carried out to determine the features of the location and architectonics of the internal jugular vein. The internal jugular vein is located outward from the common carotid artery at a depth of 2.6 cm. The surgical field is treated with an antiseptic. An ultrasound transducer is installed longitudinally to its location above the internal jugular vein in the projection of the proposed puncture, and the internal jugular vein is re-visualized on the right. After this, the jugular vein is punctured with a needle, after visualizing the needle in the lumen of the vein, a conductor is immediately inserted. A double-lumen catheter is inserted through the conductor into the internal jugular vein. Further, the entire process of conducting a catheter through the internal jugular vein on the right is carried out under constant longitudinal ultrasound monitoring. Blood clots in the jugular vein did not form upon contact with the catheter. Under ultrasound monitoring, it was determined that the end section of the catheter was behind the tricuspid valve in the cavity of the right ventricle (Figure 1, indicated by an arrow). After this, the end of the catheter is pulled into the cavity of the right atrium. There is no perforation of the tricuspid valve and the wall of the right atrium (Figure 2, arrow 1 - the end of the catheter is in the cavity of the right atrium, arrow 2 - the tricuspid valve). After the installation of a double-lumen catheter through a venous and arterial ports, a 50 ml blood was taken with a syringe. From the venous port, the syringe was filled in 6 seconds, from the arterial in 5 seconds. This indicates that the blood sampling in 1 minute from the venous port will be 500 ml, arterial 600 ml. Those. blood sampling from both ports is more than 300 ml / min. This indicates that this volume of blood will achieve an adequate blood sampling rate during the hemodialysis procedure. After the catheter was inserted, the patient was delivered to the dialysis room, connected to the dialysis machine. The blood sampling rate during the hemodialysis procedure was 350 ml / min, the duration of the session was 4 hours. After the session, the patient's condition improved, the level of creatinine, urea, potassium decreased significantly.

The proposed method has the following advantages:

1) due to constant ultrasound monitoring, determine the position of the catheter during its conduct, control the formation of blood clots in the jugular vein;

2) control of the location of the catheter in the cavity of the right atrium allows you to minimize the risk of perforation of the tricuspid valve, the wall of the right atrium and to avoid bending the end of the catheter, holding the catheter into the right ventricle, which threatens the development of heart rhythm disturbances;

3) after the installation of a double-lumen catheter through the venous and arterial ports, blood is taken with a syringe (aspiration test), which allows us to assess the adequacy of the speed of blood sampling during a hemodialysis session.

Claims (1)

A method of installing a double-lumen catheter for hemodialysis, including puncture of the jugular vein under ultrasound guidance, characterized in that they also continuously monitor ultrasound position of the double-lumen catheter along the internal jugular vein, right atrium, controlling the location of the end section of the catheter in the cavity of the right atrium and blood sampling after the catheter is inserted through the arterial and venous ports with a 50 ml syringe, if the syringe is completely filled tray than 10 seconds, it indicates that the catheter is correctly set and allows for adequate blood flow during hemodialysis.

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