心脏手术室中病人的麻醉安全问题 唐越.ppt

* Malposition of internal jugular vein catheter into contralateral internal jugular vein ; atheter tip in the left IJV th / External Jugular Venous Route for Central Venous Access: Our Experience in 563 Surgical Patients / J of anesthesia/ clinical research 2011 Catheter tip in the carotid artery * * Frontal chest radiograph shows an abnormally medial course of the catheter (arrows) in a case of inadvertent carotid cannulation * Catheter inserted in the external jugular traversing into axillary vein. * Malposition of catheter inserted in the external jugular traversing to ipsilateral internal jugular vein. / intral craneu pathology * The first chest radiograph after catheter placement of the 4 reported cases (A1, B1, C1, and D1). Images obtained with a different filter (A2, B2, C2, and D2) and detail magnification of the wires (A3, B3, C3, and D3) are also shown. Do not force. * Timing: very sick, in OR, during or after CABG. Withdraw: avoid manipulation, low tem * PAFA: pulmonary artery false aneurysm * * Catheter induced Pulmonary artery dissection. Contrast injection demonstrates an a large area of contrast extravasation (encircled) in the right pulmonary artery; Arrow indicate right pulmonary artery aneurysm (? PE pt) Figure 1. A portable chest radiograph demonstrating the right jugular vein Swan-Ganz catheter tip to be wedged in a right lower lobe PA (white arrow). Figure 2. Image from a right PA angiogram (top) showing a faint extravascular collection (arrows) adjacent to the right lower lobe PA. The pseudoaneurysm is visualized much better after a selective catheterization arteriogram of the pseudoaneurysm (bottom). * The needle is inserted at the apex of the triangle between the two heads of the sternocleidomastoid muscle, at a 45° angle to the skin in the direction of the ipselateral nipple. As before negative pressure should be applied to the syringe and the needle should enter the vein at a depth approximately 2-3 cm from the skin. * 4. Central low