| 研究生: |
黃冠傑 Huang, Guan-Jie |
|---|---|
| 論文名稱: |
超音波輔助內頸靜脈注射導引之設計與評估 Design and Evaluation of Ultrasound Needle Guide for Internal Jugular Venous Cannulation |
| 指導教授: |
張志涵
Zhang, Zhi-Han |
| 學位類別: |
碩士 Master |
| 系所名稱: |
工學院 - 生物醫學工程學系 Department of BioMedical Engineering |
| 論文出版年: | 2014 |
| 畢業學年度: | 102 |
| 語文別: | 中文 |
| 論文頁數: | 43 |
| 中文關鍵詞: | 內頸靜脈導 、管引導注射 、超音波 |
| 外文關鍵詞: | Internal jugular venous catheters, Needle guide, Ultrasound |
| 相關次數: | 點閱:139 下載:5 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
中央靜脈導管放置是臨床上常用的醫療步驟,主要是為了要獲得靜脈通道。常見的併發症有動脈刺穿、血胸、氣胸,其中又以動脈刺穿的機率最高。
之前文獻有統計全美有9.4%的人,靜脈與動脈的位置有解剖上的差異,因此近年來開始使用超音波輔助內頸靜脈注射引導(needle guide ultrasound),使用了超音波輔助後,可以有效的提高注射的成功率,但仍然無法降低總頸動脈穿刺的機率,文獻中猜測可能是因為無法去控制針頭的深度。
因此本研究製作新型超音波輔助注射導引裝置,可以用來控制針頭的深度,希望可以提高注射的成功率,並且降低動脈的穿刺的機率,透過3D 列印製作模具並搭配洋菜膠、碳粉與橡膠管,去建立出頸部假體。
本研究找了八個操作者,其中六個是沒有任何臨床扎針經驗的操作者,一個是沒有使用過超音波臨床醫生,一個是有超音波經驗的臨床醫生,隨機的使用超音波與超音波注射引導的方法,透過自製的假體去評估注射的時間、成功率以及動脈刺穿的機率。
結果發現在沒有臨床扎針經驗的操作者,使用注射引導可以有效的提高30%成功率以及降低23.3%動脈刺穿的機率,在沒有超音波經驗的臨床醫生身上,使用注射引導可以有效的提高40%成功率,在有超音波經驗的臨床醫生上,兩者方法均沒有差別,平均而言使用注射引導所花費的時間較傳統的超音波來的長大約20秒。
Central venous catheters (CVCs) are commonly used in clinical procedure to gain venous access. Common complications of using CVCs include arterial puncture, which is the most frequent, hemothorax and pneumothorax. In a previous study, 9.4% people in the United States were reported to have anatomical variations. Ultrasound needle guides are being increasingly used to improve the success rate of internal jugular vein (IJV) cannulation. However, the rate of carotid artery puncture is not reduced because the depth of the needle cannot be controlled even with the ultrasound. Therefore, a new type of needle guide is proposed in this study. The developed needle guide can be used to limit the depth of acupuncture treatment, thus improving the success rate of injection and reducing the possibility of carotid artery puncture. Further, a mold is fabricated using (three-dimensional) 3D printing, and agar, carbon dust, and a rubber tube are used to build a neck phantom. In this study, eight operators randomly used the conventional ultrasound and proposed needle guides to puncture the phantom and recorded the procedure time, success rate, and arterial puncture rate. The results showed that when a needle guide was used, a success rate of 40% was achieved and the artery injury rate was reduced to 11% but with a longer procedure time.
1. Augoustides, J.G., et al., A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department. J Cardiothorac Vasc Anesth, 2005. 19(3): p. 310-5.
2. Raad, I., Intravascular-catheter-related infections. The Lancet, 1998. 351(9106): p. 893-898.
3. Lorchirachoonkul, T., et al., Anatomical variations of the internal jugular vein: implications for successful cannulation and risk of carotid artery puncture. Singapore Med J, 2012. 53(5): p. 325-8.
4. Chantler, J., Applied Anatomy of the Central Veins, in Central Venous Catheters. 2009, Wiley-Blackwell. p. 14-33.
5. Lorchirachoonkul, T., et al., Anatomical variations of the internal jugular vein: implications for successful cannulation and risk of carotid artery puncture. Singapore Medical Journal, 2012. 53(5): p. 325-328.
6. Gordon AC, S.J., Johns D, Owen R, Gray R., US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol, 1998;9:333-8.
7. Dickson CS, R.S., Russell JM, et al., Placement of internal jugular vein central venous catheters: anatomic ultrasound assessment and literature review. Surgical Rounds, 1996. 3(102): p. 7.
8. Parillo, D.L.M.W.T.M.T.H.S.M.B.K.R.B.R.G.E.M.M.P.J.C.F.J.E., Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest. 98(1): p. 157-160.
9. Benter, T., et al., Anatomical variations in the internal jugular veins of cancer patients affecting central venous access. Anatomical variation of the internal jugular vein. Ultraschall Med, 2001. 22(1): p. 23-6.
10. Troianos, C.A., 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(12): p. 1291-318.
11. Ball, R.D., et al., Randomized, prospective, observational simulation study comparing residents' needle-guided vs free-hand ultrasound techniques for central venous catheter access. Br J Anaesth, 2012. 108(1): p. 72-9.
12. McGee, D.C. and M.K. Gould, Preventing complications of central venous catheterization. N Engl J Med, 2003. 348(12): p. 1123-33.
13. Lieberman, J.A., K.A. Williams, and A.L. Rosenberg, Optimal head rotation for internal jugular vein cannulation when relying on external landmarks. Anesth Analg, 2004. 99(4): p. 982-8, table of contents.