改良锁骨下静脉穿刺术临床应用体会  

Clinical Application of Improved Subclavion Vein Puncture

作　　者：龚建[1] 

机构地区：[1]四川省资阳市人民医院,四川资阳641300

出　　处：《医学信息》2012年第9期121-122,共2页Journal of Medical Information

摘　　要：目的通过改良锁骨下静脉穿刺术的应用，提高穿刺成功率，减少并发症。方法改良锁骨下静脉穿刺方法于锁骨中点下方1～2cm偏外侧，定位穿刺点，针尖与皮肤呈30°进针，针尖指向胸骨上窝，进针时左手拇指向下按压皮肤以利于针尖顺利通过锁骨．过锁骨后针尾下压．使针尖紧贴锁骨进针，深约3~4cm左右可有突破感，回抽见暗红色血液。即可判断针头已经进入锁骨下静脉。为保证导管方向的向0性。置管时导丝方向向I心端，头先偏向同侧稍偏再转向对侧，减小锁骨下静脉与静内静脉夹角，更好避免误入静内静脉．并将改良方法与传统方法的成功率及并发症进行比较。结果改良穿刺法穿刺成功率明显提高，达到100％，而传统穿刺法成功率仅为80％。两种穿刺方法的穿刺成功率有显著差异，P〈0．05。且穿刺并发症的发生率也明显低于传统方法组，分别为3％和30％，P〈0．05。结论改良锁骨下静脉穿刺术较传统方法更有效、更合理、更安全。Objective Through the application of the improved subclavian vein puncture and improve the success rate of puncture reduce complications. Methods The improved subclavian vein puncture method clavicular midpoint below 1 -2cm lateral Side, locate the puncture point was 30° needle tip and the skin, the needle pointing to suprasternal fossa, the needle left thumb press down on the skin in order to facilitate the smooth tip by the clavicle, over the clavicle pin tall under pressure, so that the needle close to the clavicle into the needle, the depth is about 3-4cm about a breakthrough, Withdrawing see the dark red blood, you can determine the needle has entered the subclavian vein. To ensure that the direction of the duct to the heart and mind, the direction of the guide wire when the catheter proximal end, head to favor ipsilateral Shaopian turned to the opposite, reducing the subclavian vein and static venous angle, better avoid getting into static within the vein, and improved methods and the success rate and complications of the traditional methods. Results improved puncture puncture success rate improved significantly, reaching 100%, while the traditional method of puncture success rate of 80%. Puncture success rate of the two puncture method were significantly different （P 〈0.05）. And the incidence of puncture complications was significantly lower than the traditional method group, 3% and 30% respectively （P 〈0.05）. Conclusion The modified subclavian puncture than the traditional method more efficient, more rational and safer.

关 键 词：锁骨下静脉 穿刺 成功率 并发症 

分 类 号：R472.9[医药卫生—护理学]