背景:中心静脉导管(CVC)广泛用于急诊科和重症监护病房的危重患者的管理和复苏。CVC管路的正确插入深度对于确保不间断的流动非常重要,避免并发症,并监测中心静脉压。经胸超声心动图,增强对比度,已被提议作为胸部X射线的替代方案,以高精度检测中心静脉线定位。然而,由于以前的一些相互矛盾的结果和程序的繁琐,这种方法没有被广泛使用。
方法:经机构伦理委员会批准后,这项前瞻性观察性研究是在需要中心静脉导管的患者中进行的.这项研究是在三甲医院的重症监护病房对150名成年患者进行的,目的是通过经胸超声心动图比较“快速心房漩涡标志”(RASS)技术和基于地标的技术,以确保准确的中心静脉导管放置深度。
结果:在这项研究中,我们发现超声心动图RASS组(E)的CVC平均插入深度为12.84cm,而对于地标技术组(L),它是12.02厘米。这些组之间存在显着差异,p值<0.05。我们发现,E组的大多数患者(98.63%)在1、2和3区具有导管尖端,而L组只有66.6%的患者在相似区具有导管尖端。E组胸部X线片区域的平均标准偏差为1.8,L组为2.26,两组之间存在显着差异(p值<0.05)。
结论:RASS技术在确保CVC尖端的正确深度方面优于地标技术。经胸部X光检查证实,使用RASS技术发现,大多数患者的导管尖端位于1区,2区或3区.这证实了RASS技术可以最大限度地减少资源需求,并及时加快患者管理的启动,与具有里程碑意义的技术不同,使用前需要胸部X光检查确认。
BACKGROUND: Central venous catheters (CVCs) are widely used in the management and resuscitation of critically ill patients in emergency departments and intensive care units. Correct depth of insertion of the CVC line is important to ensure uninterrupted flow, avoid complications, and monitor central venous pressure. Transthoracic echocardiography, with contrast enhancement, has been proposed as an alternative to chest X-ray in detecting central venous line positioning with high accuracy. Nevertheless, this method is not widely used due to some previous conflicting results and the cumbersomeness of the procedure.
METHODS: After approval by the Institutional Ethics Committee, this prospective observational study was carried out in patients for whom a central venous line was warranted. The study was conducted in the Intensive Care Unit of a tertiary care hospital among 150 adult patients to compare the \"Rapid Atrial Swirl Sign\" (RASS) technique by transthoracic echocardiography and the landmark-based technique for ensuring accurate depth of central venous line placement.
RESULTS: In this study, we found that the mean depth of insertion of the CVC for the Echocardiography RASS group (E) was 12.84 cm, while for the Landmark technique group (L), it was 12.02 cm. There was a significant difference between these groups, with a p-value of <0.05. We found that the majority of patients (98.63%) in Group E had the catheter tip in Zones 1, 2, and 3, while only 66.6% of patients in Group L had the catheter tip in similar zones. The mean standard deviation for zones on chest X-ray was 1.8 for Group E and 2.26 for Group L, with a significant difference between these groups (p-value <0.05).
CONCLUSIONS: The RASS technique is superior to the landmark technique in ensuring the correct depth of the tip of the CVC. When confirmed by chest X-ray, it was found that most patients had the catheter tip in Zone 1, 2, or 3 using the RASS technique. This confirms that the RASS technique can minimize the requirement of resources and hasten the initiation of patient management in a timely manner, unlike the landmark technique, which requires chest X-ray confirmation before use.