超音波ガイド下内頸静脈穿刺—琉球大学附属病院203症例での検討
血管の短軸像を基に超音波ガイド下に内頸静脈穿刺を行った. その有効性や合併症を調べるため, 過去の記録を基に検討した. 穿刺法のマニュアルを基に学習, シミュレータで練習してから, 臨床に臨んだ. 穿刺は, 医師1～3年目 (18人) が行い, 穿刺困難例では指導医師が代わった. 患者数は203人, 年齢64±13歳, 身長158±9cm, 体重58±11kgで, 初回穿刺成功率は91%, 平均穿刺回数1.1±0.5回, 総穿刺成功率は99%であった. 動脈誤穿刺が2症例に発生 (1%) し, 外科的に修復した. 適切な学習と訓練により高い穿刺成功率を得たが, 動脈誤穿刺は避け得なかった. 今...
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| Published in | 日本臨床麻酔学会誌 Vol. 28; no. 3; pp. 439 - 446 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2008
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.28.439 |
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| Abstract | 血管の短軸像を基に超音波ガイド下に内頸静脈穿刺を行った. その有効性や合併症を調べるため, 過去の記録を基に検討した. 穿刺法のマニュアルを基に学習, シミュレータで練習してから, 臨床に臨んだ. 穿刺は, 医師1～3年目 (18人) が行い, 穿刺困難例では指導医師が代わった. 患者数は203人, 年齢64±13歳, 身長158±9cm, 体重58±11kgで, 初回穿刺成功率は91%, 平均穿刺回数1.1±0.5回, 総穿刺成功率は99%であった. 動脈誤穿刺が2症例に発生 (1%) し, 外科的に修復した. 適切な学習と訓練により高い穿刺成功率を得たが, 動脈誤穿刺は避け得なかった. 今後の課題は合併症回避のための訓練法にある. |
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| AbstractList | 血管の短軸像を基に超音波ガイド下に内頸静脈穿刺を行った. その有効性や合併症を調べるため, 過去の記録を基に検討した. 穿刺法のマニュアルを基に学習, シミュレータで練習してから, 臨床に臨んだ. 穿刺は, 医師1～3年目 (18人) が行い, 穿刺困難例では指導医師が代わった. 患者数は203人, 年齢64±13歳, 身長158±9cm, 体重58±11kgで, 初回穿刺成功率は91%, 平均穿刺回数1.1±0.5回, 総穿刺成功率は99%であった. 動脈誤穿刺が2症例に発生 (1%) し, 外科的に修復した. 適切な学習と訓練により高い穿刺成功率を得たが, 動脈誤穿刺は避け得なかった. 今後の課題は合併症回避のための訓練法にある. |
| Author | 宮田, 裕史 新田, 憲市 照屋, 孝二 比嘉, 達也 須加原, 一博 徳嶺, 譲芳 |
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| References | 5) Troianos CA, Jobes DR, Ellison N: Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 72: 823-826, 1991 2) 徳嶺譲芳: 総論, 各論 1. 内頚静脈穿刺, 超音波ガイド下中心静脈穿刺法マニュアル. 須加原一博編. 総合医学社, 東京, 2007, 3-49 7) National Institute for Health and Clinical Excellence: NICE Technology Appraisal Guidance-No. 49. (http://www.nice.org.uk 9) Gordon AC, Saliken JC, Johns D, et al. : US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 9: 333-338, 1998 8) Karakitsos D, Labropoulos N, Groot ED, et al. : Real-time ultrasound-guided catheterization of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Critical Care 10: R162, 2006 (http://ccforum.com/content/10/6/R162 10) Docktor B, So CB, Saliken JC, et al. : Ultrasound monitoring in cannulation of the internal jugular vein: anatomic and technical considerations. Can Assoc Radiol J 47: 195-201, 1996 13) Suzuki T, Hasegawa J, Ito K, et al. : The usefulness of the 22-guage Safe Guide® based on penetration force and pattern of venous regurgitation. Circ Cont 21: 427-433, 2000 3) Legler D, Nugent M: Doppler localization of the internal jugular vein facilitates central venous cannulation. Anesthesiology 60: 481-482, 1984 12) Mangar D, Turnage WS, Mohamed SA: Is the internal jugular vein cannulated during insertion or withdrawal of the needle during central venous cannulation? Anesth Analg 76: 1375, 1993 4) Mallory DL, McGee WT, Shawker TH, et al. : Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest 98: 157-160, 1990 6) Denys BG, Uretsky BF, Reddy PS: Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 87: 1557-1562, 1993 1) Agency for Healthcare Research and Quality: Ultrasound guidance of central venous catheterization, Making Health Care Safer: A Critical Analysis of Patient Safety Practices. AHRQ Publication 01-E058. (http://www.ahcpr.gov/clinic/ptsafety 11) 鈴木利保, 金沢正浩, 滝口守: 内頸静脈穿刺法とその注意点. 臨外 55: 1505-1509, 2000 |
| References_xml | – reference: 1) Agency for Healthcare Research and Quality: Ultrasound guidance of central venous catheterization, Making Health Care Safer: A Critical Analysis of Patient Safety Practices. AHRQ Publication 01-E058. (http://www.ahcpr.gov/clinic/ptsafety/) – reference: 12) Mangar D, Turnage WS, Mohamed SA: Is the internal jugular vein cannulated during insertion or withdrawal of the needle during central venous cannulation? Anesth Analg 76: 1375, 1993 – reference: 5) Troianos CA, Jobes DR, Ellison N: Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 72: 823-826, 1991 – reference: 11) 鈴木利保, 金沢正浩, 滝口守: 内頸静脈穿刺法とその注意点. 臨外 55: 1505-1509, 2000 – reference: 10) Docktor B, So CB, Saliken JC, et al. : Ultrasound monitoring in cannulation of the internal jugular vein: anatomic and technical considerations. Can Assoc Radiol J 47: 195-201, 1996 – reference: 3) Legler D, Nugent M: Doppler localization of the internal jugular vein facilitates central venous cannulation. Anesthesiology 60: 481-482, 1984 – reference: 6) Denys BG, Uretsky BF, Reddy PS: Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 87: 1557-1562, 1993 – reference: 8) Karakitsos D, Labropoulos N, Groot ED, et al. : Real-time ultrasound-guided catheterization of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Critical Care 10: R162, 2006 (http://ccforum.com/content/10/6/R162) – reference: 2) 徳嶺譲芳: 総論, 各論 1. 内頚静脈穿刺, 超音波ガイド下中心静脈穿刺法マニュアル. 須加原一博編. 総合医学社, 東京, 2007, 3-49 – reference: 13) Suzuki T, Hasegawa J, Ito K, et al. : The usefulness of the 22-guage Safe Guide® based on penetration force and pattern of venous regurgitation. Circ Cont 21: 427-433, 2000 – reference: 9) Gordon AC, Saliken JC, Johns D, et al. : US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 9: 333-338, 1998 – reference: 4) Mallory DL, McGee WT, Shawker TH, et al. : Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest 98: 157-160, 1990 – reference: 7) National Institute for Health and Clinical Excellence: NICE Technology Appraisal Guidance-No. 49. (http://www.nice.org.uk) |
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| Title | 超音波ガイド下内頸静脈穿刺—琉球大学附属病院203症例での検討 |
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