Japanese
Title内頚静脈穿刺法の工夫：超音波診断装置の応用
Subtitle原著
Authors鈴木利保, 杵淵嘉夫, 竹山和秀, 西山純一, 金沢正浩, 滝口守, 山崎陽之介, 山本道雄
Authors(kana)
Organization東海大学医学部麻酔科学教室
Journal循環制御
Volume14
Number3
Page313-320
Year/Month1993/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」内頸静脈を穿刺する際, トレンデレンブルグ体位にしたり, 麻酔バッグを加圧して, 静脈を怒脹させると容易になる. これらの操作がどのくらい有効かを, 麻酔下の成人患者52名において, 超音波診断装置を用いて検討した. 最も有効であったのは, 15度トレンデレンブルグ体位で, バッグを加圧保持したときで, 断面積で1.7倍, 直径で, 1.3〜1.4倍増大した. (水平位, 無加圧に比べて, 断面積 104.9±79.4mm2から170.6±89.8mm2, 横径 11.8±3.2mmから17.1±4.1mm 縦径 9.3±32mmから12.0±2.4mm) バッグの加圧保持は, 極めて有効で, 逆トレンデレンブルグ体位(頭側高位)でも加圧保持すれば, トレンデレンブルグ体位(頭側低位)無加圧と同程度の怒脹が得られた. 総頸動脈と内頸静脈との位置関係についてエコー所見上, 3種に分けられる. [1)動静脈が完全に重なっている 4％] [2)動静脈が完全に離れている 12％] [3)部分的に(1/2-1/3)重なっている 85％] 完全に重なっている例では, 穿刺針が静脈を貫いて動脈を串刺しにするおそれがある. 穿刺時に皮膚を引張って固定性をよくするとか, 総頸動脈を圧排することがよく言われているが, エコー視下では, これらの操作は常に内頸静脈を圧迫して, その直径を20％−30％減少させ, 穿刺を難しくしていることが解った. 中心静脈カテーテルのイントロデューサとして太い穿刺針(例えば13ゲージメディキット)を使うと, 内頸静脈は, 強く圧迫され, 前壁だけを穿通して, 静脈腔内に止ることは困難と思われた. この操作には, 出来るだけ細い穿刺針を使い, 細いガイドワイヤーを挿入するSeldinger法を利用すべきであろう. 超音波診断装置は, 内頸静脈穿刺に有用な補助手段であることがわかった.
Practice基礎医学・関連科学
Keywords
English
TitleHow to cannulate the internal jugular vein with ease: ultrasonographic aid
Subtitle
AuthorsToshiyasu Suzuki, Yoshio Kinefuchi, Kazuhide Takeyama, Junichi Nishiyama, Sazuhiro Kanazawa, Manoru Takiguchi, Yonosuke Yamasaki, Michio Yamamoto
Authors(kana)
OrganizationDepartment of Anesthesiology,Tokai University School of Medicine
JournalCirculation Control
Volume14
Number3
Page313-320
Year/Month1993/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractVarious maneuvers such as tilting the table or squeezing the anesthesia bag can distend the internal jugular vein and make its cannulation easier. We evaluated the efficacy of these maneuvers by ultrasonography in 52 anesthetized patients. We found that the most effective maneuver was a combination of a head-down tilt (15 degrees) and Valsalva maneuver (the anesthesia bag being held squeezed at 15 cm H20 airway pressure). The cross-sectionanl area of the vein increased by 1.7 times, from 104.9±79.4 mm2 (control: horizontal table with zero airway pressure) to 170.6±89.8 mm2, its axes increased by 1,3 to 1.4 times (the short axis from 9.3±3.2 mm to 12.0±2.4 mm, the long axis from 11.8±3.2 to 17.1±4.1 mm) The raised airway pressure alone was found just as effective as head-down tilt alone in distending the vein because the former caused a similar degree of distention even in head-up position. Three patterns were discerned in the alignement of the vein in relation the common carotid artery [1) complete overlapping of the vessels 4%] [2) complele separation 12%] [3) partial overlapping of the vessels 85%] In those cases where the vessels completely overlap, the advancing needle may easily transfix the vein and enter the common carotid artery. Other maneuvers often recommended to facilitate the puncture such as the countertraction of the skin and the digital retraction of the common carotid artery may complicate the procedure because these invariably compress the vein to reduce its diameter by 20 to 30%. The size of the cannulas used as the introducer also has to do with compression of the vein. A large bore cannula (e.g. 13 gauge Medicut cannula) was seen on ultrasonogram to displace and to compress the vein as it advances toward it. It would make it diffiult to penetrate only the anterior wall and keep the tip in the venous lumen. We recommend the use of smaller cannula in combination with a Seldinger-type guide-wire. More frequent use of ultra-sonograph should be made in internal jugular vein cannulation especially in cases where technical difficulties are anticipated.
PracticeBasic medicine
Keywords

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