婴幼儿中心静脉置管通用课件.pptVIP

婴幼儿中心静脉置管陈锡明上海交通大学医学院附属新华医院麻醉科

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置管途径l–

置管途径llllll

颈内静脉lllll按成功率

1.Hsternalnotch.oidcartilage.2,3.Mid4.Low5.

颈内静脉穿刺入路

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穿刺方法

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20

21

22

锁骨下静脉lll

锁骨下静脉llllll–

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股静脉ll

股静脉

脐静脉lll

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脐静脉置管l

外周导入中心静脉置管ll22例极低出生体重儿lllll儿中的应用

外周导入中心静脉置管lllll

经胸直接心腔内置管lll

超声辅助技术ll

超声多普勒血流探测器l

AudioDo

Two-dimeonalultrasoundviewoftheinternaljugularvein(largercircle,abovatherightofthesmallercarotidartery).38

ThetipoftherightinternaljugularcatheterisintheSVC,6mmabovetheRA.

l管的位–An

导管尖端位于右房内1.8mm

最佳置管深度颈内静脉和锁骨下静脉lll

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l深度(cm)=身高(cm)/10-1深度(cm)=身高(cm)/10-2–身–

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右侧颈内静脉/锁骨下静脉置管深度

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Postoperativechestradiographwiththetipofarightinternaljugularveincatheterinthemid-superiorvenacava.

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ThecarinaisnotalandmarkforcentralvenouscatheterplacementinneonatesPediatricAnesthesia200717:968–971

Age:postconceptionalage(gestationalageinweeks+weeksafterdelivery);distance:longitudinaldistancebetweenthecarinaandPR,positivedistancemeansthePRisabovethecarinaandnegativedistancemeansthePRisbelowthecarina.PR,pericardialreflection;PediatricAnesthesia200717:968–971

经股静脉中心静脉导管尖端最佳深度ll

×kg+8.13CorrelationL3levelpatiens(tothethe

中心静脉导管与长度的选择

asveins.RothB.Anarteryip008decarotidthesa,

Ultrasountheint

AgeLIJVRIJVMean(months)60.99±0.131.00±0.130.99±0.130.89±0.110.91±0.130.90±0.127-1818-600.97±0.140.94±0.150.96±0.14

18-69*

导管位置不当l

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并发症lllll短期儿。并

感染控制ll导l

谢谢68