实时超声引导的血管穿刺技术ppt课件.ppt

ICU实时超声引导的血管穿刺技术;导管;血管插管可能带来各种各样的并发症，甚至严重致命并发症！！！ 昂贵的导管如果插管不成功？？？;实时超声引导的血管插管技术;深静脉穿刺置管;深静脉穿刺并发症;病人临床管理十大安全策略 Ann Intern Med. 2013;实时超声引导深静脉穿刺置管 --颈内静脉;R-IJV 颈部血肿;急性脑梗塞 颈动脉斑块;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;Hoffman T,et al. CVC an Anatomical review, Clinical Anatomy Doi:10.1002/ca22768;有了超声！！;IJV693543 左侧优势;IJV V-A上下;R-IJV;R-IJV;R-IJV;R-IJV Single L.;R-IJV Double L.;RIJV 导丝异位;RIJV ;推荐:提高穿刺成功率,减少穿刺时间,减少并发症;实时超声引导深静脉穿刺置管 --股静脉;common femoral artery and vein;左侧股动静脉 解剖关系;左侧股动静脉 解剖位置;左侧股动静脉 解剖位置;股动静脉位置—垂直;怎么办？？？;common femoral vein;左侧股静脉 透析导管;股静脉在动脉下方—难！？;最新指南： 颈内静脉、股静脉插管应该使用超声引导技术;实时超声引导深静脉穿刺置管 --锁骨下静脉;SCV穿刺困难及风险;静脉至 胸膜距离;动脉紧贴静脉下方;L-SCV 盲穿 颈部血肿;静脉与动脉间距;左右不对称;不对称 左侧优势;SCV双侧塌陷;呼吸变异度;呼吸变异度;为什么还是锁骨下静脉？ …….;中国CRBSI防控指南2010;美国CDC指南2011;美国ASA指南2012;P. Frykholm et al. Clinical guidelines on central venous catheterisation; Acta Anaesthesiol Scand 2014; 58: 508–524;新策略 US定位标记;SCV;US定位;R-SCV 气胸;实时超声引导动脉穿刺置管 --股动脉;股动脉穿刺并发症;CFA置管----导管室;左侧股动静脉;common femoral artery ;R-CFA;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;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; ICU真正“可视化”的医学时代已经来临 An era of genuine “visual” medicine in the ICU ;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 …….;谢谢