超音波導引下中央靜脈管路放置法

癌末病人常常虛弱，無法正常飲食，病人常表達需要點滴注射的意願，而家屬也常以要求醫師給予點滴注射，以表達對病人的關心，病人的意願常常是醫師開立點滴注射醫囑最強的影響因子。然而安寧病房的病人多歷經治療，周邊血管常常不易打上點滴，放置中央靜脈管路，常成為另一種選擇，一般放置中央靜脈導管，傳統上依靠體表特徵(landmark)，但在一些病人，如肥胖者、短脖子者、化學治療過之病人、休克者血管不易打上，血小板低下者、甚至外傷者、疑頸椎傷害頭部須保持直線，難以使用體表特徵者及易出血體質的病人，則此種方法常常面臨挑戰，常見之併發症有：打到動脈、動靜脈交通、氣胸、神經受傷、血腫等。傳統方法失敗率有報導可達35%(5)，併發症的發生率則在10%。本文用意在介紹超音波導引下放置中央靜脈管路比傳統找尋體表特徵(landmark)有許多好處，提高成功率，減少併發症，讓病人減少痛苦，對施打者可降低針扎之風險，而使用超音波導引成功率與超音波使用經驗及靜脈內徑及病人之合作度有關。

關鍵字

超音波導引；中央靜脈

並列摘要

The terminally ill cancer patients are usually frail and have very limited oral intake. These patients often ask for parenteral fluid supplementation and their family would urge such measure to show their care. Respecting patient's autonomy is one of the priorities in the hospice ward and his or her wish frequently influence the physician's treatment plan. Due to the frequent failure to establish a peripheral intravenous access, central venous cannulation is often considered. Normally the needle entrance site is determined by certain landmarks on the skin and the needle is passed through the skin blindly. With jugular approach the patient's head must be turned to the side and kept in that position throughout the procedure. For many patients such positioning is uncomfortable and at times it can be dangerous, especially if the patient is intubated or if there is suspicion of cervical spine injury. In some patients with short and obese neck the procedure can be difficult to accomplish. The complications of the central venous cannulation include local hematoma, pneumothorax, arterial puncture, arteriovenous fistula and nerve damage. The performer of the procedure also carries the risk of accidental needle puncture. The failure rate of the cannulation can be as high as 35% and the complication rate up to 10%. The method of ultrasound-guided central venous cannulation is safe and can reduce the rate of complication while increase the chance of success and the patient's comfort. This safer method is described in this paper. The factors that contributing to the success are the size of the vein, the patient's ability to cooperate, and the experience of the sonographer/operator.

並列關鍵字

ultrasound guide ； central vein

國際替代計量

超音波導引下中央靜脈管路放置法

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