安全な中心静脈カテーテル挿入 ... - anesth.or.jp

1 1 2017 2017 6 WG 2 I 4 II 4 III 6 IV 8 8 10 10 peripherally inserted central catheter: PICC 11 V 11 11 Pre-procedure ultrasound examination (Prescan) 12 13 15 16 A.

2 16 B. 17 C. Prescan 18 D. 18 E. 18 F. 20 G. 20 H. 20 Static approach 21 Real-time approach 24 Short axis out of plane technique: SAX-OOP technique 24 26 Long axis in plane technique: LAX-IP technique 30 3 31 VI 32 VII 34 VIII 40 1 40 2 41 3 41 4 41 5 42 6 42 7 42 IX 42 X

3 44 XI 45 45 46 46 XII. 50 4 I II peripherally inserted central 5 catheter.

4 PICC [1] [2][3] X 6 III [4] 127 [5][6]

5 [7] [8] 7 8 IV [9][10] [10] 1 1 [11] 1 9 2 12 [12] 2 SA: CA: IJV.

6 10 [10] 1/3 1/3 [13] [14] [10] 11 peripherally inserted central catheter: PICC PICC PICC [15] V [16][17][18] Anatomical landmark technique Ultrasound-guided technique 12 Pre-procedure ultrasound examination.

7 Prescan[18] Static approach Real-time approach Real-time approach Prescan Prescan Pre-procedure ultrasound examination (Prescan)[18] Prescan 3. Prescan Prescan Prescan Static approach [16][19] 13 3 3A IJV CA 3B [1] PICC 1 [17] Prescan 14 1 1 [1][15]

8 Pinch-off syndrome* PICC 15 Pinch-off syndrome CDC [20] [21][22] [23] PICC [24] X. BMI> 30 , BMI < 20 [25][26] [26] [25][26] [26] [26] [25] [26] [26][27] 16 PICC CT 5 /mm3 PT-INR APTT [1] [28] A.

9 B. C. Pre-procedure ultrasound examination (Prescan) D. Maximal sterile barrier precautions (MBP) E. F. [29][30] G. H. I. A. 17 B. Trendelenburg [31] 10 20 10 [11] [32] 18 [33] PEEP 5 10cm [34][35] Trendelenburg [36] 30 [37] C.

10 Prescan D. [20][28] Maximal sterile barrier precautions: MBP MBP XI. E. Seldinger 19 modified Seldinger Seldinger 18G 20 22G Through-the-needle/cannula through-the-cannula splitting sheath 16G Seldinger modified Seldinger