小児先天性心疾患手術症例における内頸静脈エコーガイド下中心静脈カテーテル留置

摘要

Central venous catheterization is essential for the anesthetic management of operations for congenital heart diseases. We prospectively examined the usefulness of ultrasonography in internal jugular vein catheterization in infants.Internal jugular vein cannulation was guided using an ultrasound image scanner in 96 pediat-ric cardiac patients. We investigated the rate of successful catheterizations, the number of attempts, the time from venipuncture to wire insertion, and the laterality of internal jugular vein diameters.The success rate in all 96 patients was 95.8% with no carotid artery puncture.Patients younger than 12 month of age had success rates of 90%.In patients younger than 1 month of age and with weights less than 3.4 kg,the success rate was 76.9%. The time from venipuncture to proper wire insertion in the first attempt (55.2%) was 50.8+-18.9s;157.3+-56.4s for second attempt (18.8%);285.7 +165.7s for third attempt (7.6%) ; 346.0+-98.4s for fourth attempt (5.5%);and 510.0+-98.4s for fifth attempt (2.1%).The time requited was 1404.5+-518.4s for attempts that required more than seven passes. Cannulations in four cases were unsuccessful because the image of the internal jugular vein was difficult to visualize. The left internal jugular vein diameter was larger than the right in 40 cases. In three unsuccessful cases, the diameter was less than 4.5 mm.Internal jugular vein cannulation guided by ultrasonography can be performed safely and quickly in pediatric patients.