Application of thromboelastography combined with point-of-care ultrasound to prevent internal jugular vein catheterization related thrombosis
10.3760/cma.j.cn121430-20200416-00302
- VernacularTitle:血栓弹力图联合床旁B超指导预防颈内静脉置管后血栓形成的价值研究
- Author:
Yueqin LUO
1
;
Ming ZHOU
;
Bolei WANG
Author Information
1. 北海市人民医院重症医学科，广西壮族自治区北海 536000
- From:
Chinese Critical Care Medicine
2020;32(8):994-997
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis.Methods:The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded.Results:Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm 3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. Conclusion:Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.
