Mise en place échoguidée des cathéters veineux centraux

Lavoisier - Tập 22 - Trang 196-203 - 2013
J. Maizel1, M. Slama1
1Unité de réanimation médicale du service de néphrologie et Inserm U1088, CHU d’Amiens, université de Picardie, Amiens, France

Tóm tắt

La mise en place des cathéters veineux centraux (CVC) est un des gestes les plus fréquents en réanimation et qui n’est pas sans risque pour le patient. Quand l’échographie bidimensionnelle n’existait pas, le praticien n’avait pas d’autre choix que d’utiliser les repères anatomiques. Ils permettaient de trouver la veine dans la grande majorité des cas. Mais parce qu’il existe des variations anatomiques, cette technique anatomique était parfois à l’origine d’échecs et de complications mécaniques graves. L’utilisation des ultrasons a permis de voir ce que le médecin ne faisait que palper. Rapidement, l’échographie en guidant la ponction jusque dans la veine a montré qu’elle apportait une amélioration du taux de succès, du nombre de ponctions, du temps de pose, du nombre de complications, du confort et du coût. Si les médecins doivent continuer à savoir mettre des CVC à l’aide des seuls repères anatomiques, l’utilisation de l’échoguidage doit être considérée comme la technique de référence en accord avec les recommandations actuelles.

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