Ultrasound assisted catheterization of internal jugular vein
Ultrason yardımlı internal juguler ven kateterizasyonu
Keywords:
Anahtar Kelimeler: Hemodiyaliz, Ultrason, Venöz Yol, KateterizasyonAbstract
An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodialysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV localization, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis.
A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Training and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2).
The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident.
USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates.
Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter intervention should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily performed by all clinicians and residents, since the training period is short, practical and much more safe.
ÖZET
Hemodiyalizin başarısı için her zaman uygun bir damar yoluna ihtiyaç vardır. İnternal juguler ven (IJV) santral venler arasında en güvenli ve az komplikasyonlu yoldur. Aynı zaman da hemodiyaliz için en sık kullanılan geçici vasküler yoldur. Birçok merkezde santral vasküler yol için anatomik işaretleme sonrası körleme (blind) yöntem en çok kullanılan tekniktir. Hemodiyaliz kateterlerinin santral vene yerleştirilmesinde ultrason kullanımı kateterizasyon başarı oranını yükseltir. Ultrason internal jügüler ven (IJV) lokalizasyonunu, anatomik varyasyonlarını, ven içinde trombus varlığını ve venin açık olup olmadığını gösterebilir. Bu çalışmanın amacı hemodiyaliz amacıyla İJV’e ultrason yardımlı ve yardımsız olarak yerleştirilen geçici kateterlerin başarı oranı ve komplikasyon sıklığını karşılaştırmaktır.
Şubat 2012- Aralık 2012 tarihleri arasında Haydarpaşa Numune Eğitim ve Araştırma hastanesinde hemodiyaliz kateter gereksinimi olan ardışık toplam 124 hasta randomize edilerek çalışmaya alındı Hastalar ultrasonografi (USG) yardımsız (körlemesine) (Grup 1), ultrason yardımlı (Grup 2) olmak üzere iki gruba ayrıldı.
Ultrason kullanımı hem deneyimli uzman hem de asistanın başarılı kateterizasyon oranlarını anlamlı olarak yükseltti. Ayrıca Uzman ile asistan arasındaki başarı oranları arasında istatistiksel fark saptanmadı.
USG yardımlı ven kateterizasyonu güvenli, kolay, hızlı, daha ağrısız, en az komplikasyon oranları ile gerçekleştirilebilir. Geçici kateter gereksinimi olan riskli hasta guruplarında kateter girişimi mutlaka USG kılavuzluğunda yapılmalıdır. USG’si olmayan merkezlerde özellikle bu tür riskli hastalara anatomik işaretleme sonrası körleme kateter girişimi hiç denenmemelidir. USG yardımlı ven kateterizasyonu işlemi eğitim süreci kısa, pratik ve çok daha fazla güvenli olması nedeniyle tüm klinisyenler ve asistanlar tarafından kolaylıkla yapılabilir.
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