实时超声引导的血管穿刺技术课件.ppt

实时超声引导动脉穿刺置管 --股动脉 股动脉穿刺并发症 (1) Vessel laceration (1%) (2) Acute vessel closure (1%) (3) 假性动脉瘤(1–6%) (4) Arteriovenous ?stula formation (1%) (5) 血肿(6–10%) (6) Venous thrombosis (7) Excessive bleeding (8) Pericatheter clot Irani et al. Common femoral artery access techniques: a review； Journal of Cardiovascular Medicine 2009, 10:517–522 CFA置管----导管室 Robert Feldman, Precise Location of Ideal Common Femoral Artery Puncture Site；C A R D I O V A S C U L A R I N T E R V E N T I O N S , 2 0 1 4（7）：229-30 左侧股动静脉 右 内侧 左 外侧 common femoral artery Critical Care Bedside Us R-CFA Real US-Guide Axillary artery liver abscess Brachial artery Radial artery Ultrasound is most effectively used as a rescue technique for arterial access and to identify the location and patency of suitable arteries for cannulation or procedural access LAX imaging is particularly useful Troianos et al;Guidelines for Performing Ultrasound Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; J Am Soc Echocardiogr 2011;24:1291-318 提高血管插管成功率，减少并发症 一项几乎近于完美的技术 ultrasound guidance standard practice 结论：Real-US引导血管插管技术 —比较传统盲插技术优势 ICU真正“可视化”的医学时代已经来临 An era of genuine “visual” medicine in the ICU D. Lichtenstein Journal of Critical Care (2012) 27, 533 point-of-care lung ultrasound肺部超声 Cardiac Echocardiography心脏超声 Protocols of thoracic US胸部超声 US utility in majory trauma严重创伤 Ultrasound-guided Procedures超声引导介入 ……. 重症超声 谢谢 实时超声引导的血管插管技术 使ICU重症患者更安全 左侧股动静脉 解剖位置 2cm 1cm 左侧股动静脉 解剖位置 右 左 4cm 3cm 右 内侧 股动静脉位置—垂直 D-CFA D-CFV S-CFV S-CFA 怎么办？？？ common femoral vein Real US-Guide 实时超声引导 直视下穿刺 左侧股静脉 透析导管 股静脉在动脉下方—难！？ Real US-Guide 让不可能成为可能 最新指南： 颈内静脉、股静脉插管应该使用超声引导技术 P. Frykholm et al. Clinical guidelines on central venous catheterisation; Acta Anaesthesiol Scand 2014; 58: 508–524 实时超声引导深静脉穿刺置管