외상 환자에서 초음파 유도 내경정맥 도관 삽입 시카테터 바늘과 피부 사이의 적정 각도

• Published in: Daehan oe'sang haghoeji Vol. 26; no. 3; pp. 183 - 189
• Main Authors: 전현민, Hyun Min Jeon, 정성민, Sung Min Jung, 정루비, Ru Bi Jung, 전진, Jin Jeon, 홍종근, Chong Kun Hong, 신태용, Tae Yong Shin, 하영록, Young Rock Ha, 김영식, Young Sik Kim
• Format: Journal Article
• Language: Korean
• Published: 대한외상학회 30-09-2013
• Subjects: Catheterization; Central vein; Intervention; Ultrasonography
• ISSN: 1738-8767; 2287-1683

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV`s anterior-posterior (AP) vessel wall on the longitudinal scan`s midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV`s internal center on screen`s midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5≤ middle CVP ≤10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68±0.30, 1.06±0.31, and 1.23±0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups` mean optimal angles (28.1±6.1, 30.1±4.5, and 28.0±5.0 degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV`s diameter is altered in proportion to the CVP.