Skip to main content
SpringerLink
Log in

Darstellbarkeit der Vena cava superior im rechten supraklavikulären Schallfenster

Visualization of the superior vena cava in the supraclavicular acoustic window

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Ultraschall-gesteuerte Anlage eines Zentralvenösen Katheters (ZVK) über die Vena jugularis interna dextra mit einem Linearschallkopf ist ein etabliertes Verfahren. Bislang sind für die ZVK-Lagekontrolle Methoden wie intrakardiales EKG oder Röntgenthoraxaufnahme bekannt. Wir konnten mit einem Mikrokonvexschallkopf die Fossa supraclavicularis dextra als Schallfenster für die Darstellung der Vena cava superior (VCS) für die ultraschall-gesteuerte ZVK-Lagekontrolle etablieren. Limitierend ist jedoch die geringe Verbreitung des Mikrokonvexschallkopfs. Daher haben wir in der vorliegenden Probandenstudie systematisch die Darstellbarkeit der intrathorakalen Gefäße über das rechte supraklavikuläre Fenster mit einem Linearschallkopf und einem Mikrokonvexschallkopf verglichen.

Methode

Wir evaluierten bei 30 Probanden die Darstellbarkeit der VCS, der Venae brachiocephalicae, des Zusammenflusses der Venae brachiocephalicae (Confl.), der rechten Pulmonalarterie, der Aorta ascendens und der Vena jugularis interna mit dem Mikrokonvex- und Linearschallkopf in der Anlotung über die Fossa supraclavicularis dextra. Die VCS wurde auch mittels Doppler verifiziert.

Ergebnisse

Mit dem Mikrokonvexschallkopf ließ sich bei allen Probanden die VCS darstellen, mit dem Linearschallkopf hingegen nur bei 53 %. Die kombinierte Sichtbarkeit von VCS und Arteria pulmonalis dextra war mit dem Mikrokonvexschallkopf in allen Fällen gegeben, mit dem Linearschallkopf nur in 38 %. Confl. beziehungsweise Aorta war bei 57 %/87 % mit dem Mikrokonvexschallkopf sichtbar, in 35 %/30 % mit dem Linearschallkopf. Die Vena jugularis interna war bei allen Probanden mit beiden Sonden sichtbar.

Schlussfolgerung

Der Mikrokonvexschallkopf ist für die Darstellbarkeit der VCS dem Linearschallkopf klar überlegen. Wahrscheinliche Gründe hierfür liegen in der kleineren Auflagefläche, der größeren Angulationsfreiheit und der höheren Eindringtiefe der Mikrokonvexsonde.

Abstract

Background

The ultrasound-guided venipuncture of the internal jugular vein for placement of a central venous catheter is well established. For verification of the catheter tip position mostly intracardiac ECG or chest radiography are used. Previously, we established the right supraclavicular fossa view for ultrasound based verification of the catheter placement in the superior vena cava utilizing a microconvex probe. The microconvex probe has a small footprint. However, not all ultrasound systems used in the operating theater are equipped with a microconvex transducer.

Aim

Thus, we systematically compared the visibility of intrathoracic vessels obtained by a linear and a microconvex prone via the right supraclavicular view.

Material and methods

We assessed the visibility of the junction of the brachiocephalic veins, the superior vena cava, the right pulmonary artery, the ascending aorta and the internal jugular vein, comparing a linear with a microconvex probe when using the right supraclavicular view in healthy volunteers. The superior vena cava also was identified using Doppler ultrasound.

Results

With the microconvex probe the superior vena cava was visible in all 30 healthy volunteers, but with a linear transducer it was visible in only 53 %. The combined view of the superior vena cava and the right pulmonary artery was possible in all cases when using the microconvex probe, but in only 38 % when using the linear probe. The junction of the brachiocephalic veins was seen in 75 % of the volunteers with the microconvex probe and in 38 % with the linear one. The aorta was visible in 87 % of cases with the microconvex transducer, but only in 30 % with the linear probe. The internal jugular vein was always visible with either probe.

Conclusion

The microconvex transducer as compared to the linear probe is superior in visualizing the superior vena cava. Possible reasons are a smaller footprint, a better degree of freedom for angulation and a greater penetration depth of the microconvex probe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Alrajab S, Youssef AM, Akkus NI, Caldito G (2013) Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care 17:R208 doi:10.1186/cc13016

    Article  PubMed  PubMed Central  Google Scholar 

  2. Alrajhi K, Woo MY, Vaillancourt C (2012) Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 141:703–708. doi:10.1378/chest.11–0131

    Article  PubMed  Google Scholar 

  3. Dassinger MS, Renaud EJ, Goldin A et al (2015) Use of real-time ultrasound during central venous catheter placement: Results of an APSA survey. J Pediatr Surg 50:1162–1167. doi:10.1016/j.jpedsurg.2015.03.003

    Article  PubMed  Google Scholar 

  4. Einhaus F, Greim C‑A (2015) General principles of sonography, part 1 : Basic physics, imaging and Doppler techniques. Anaesthesist doi:10.1007/s00101-015-0096-5

    Google Scholar 

  5. Fletcher SJ, Bodenham AR (2000) Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth 85:188–191

    Article  CAS  PubMed  Google Scholar 

  6. Hilbert T, Weber S, Knies R, Kim S‑C (2015) Value of ultrasound with a single linear transducer to confirm correct positioning of central venous catheter in low body weight neonates. Eur J Anaesthesiol 32:893–894. doi:10.1097/EJA.0000000000000337

    PubMed  Google Scholar 

  7. Katheria AC, Fleming SE, Kim JH (2013) A randomized controlled trial of ultrasound-guided peripherally inserted central catheters compared with standard radiograph in neonates. J Perinatol 33:791–794. doi:10.1038/jp.2013.58

    Article  CAS  PubMed  Google Scholar 

  8. Kim S‑C, Heinze I, Schmiedel A et al (2015) Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe: an observational pilot study. Eur J Anaesthesiol 32:29–36. doi:10.1097/EJA.0000000000000042

    Article  PubMed  Google Scholar 

  9. Kim S‑C, Klebach C, Heinze I et al (2014) The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire. J Vis Exp doi:10.3791/52160

    Google Scholar 

  10. Lanspa MJ, Fair J, Hirshberg EL et al (2014) Ultrasound-guided subclavian vein cannulation using a micro-convex ultrasound probe. Ann Am Thorac Soc 11:583–586. doi:10.1513/AnnalsATS.201311-414BC

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lichtenstein DA, Mezière G, Lascols N et al (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33:1231–1238

    Article  PubMed  Google Scholar 

  12. Pittiruti M, Bertollo D, Briglia E et al (2012) The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 13:357–365. doi:10.5301/JVA.2012.9020

    Article  PubMed  Google Scholar 

  13. Von Sarnowski B, Khaw AV, Kessler C, Schminke U (2010) Evaluation of a microconvex array transducer for the ultrasonographic examination of the intrathoracic segments of the supraaortic arteries. J Neuroimaging 20:246–250. doi:10.1111/j.1552-6569.2009.00360.x

    Article  Google Scholar 

  14. Shala MBA, D’Cruz IA, Johns C et al (1998) Echocardiography of the inferior Vena Cava, superior Vena Cava, and coronary sinus in right heart failure. Echocardiography 15:787–794

    Article  PubMed  Google Scholar 

  15. Stonelake PA, Bodenham AR (2006) The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth 96:335–340. doi:10.1093/bja/aei310

    Article  CAS  PubMed  Google Scholar 

  16. Trautner H, Markus CK, Steinhübel B et al (2011) The DGAI training module 2 in anaesthetic focussed sonography: vascular sonography. Anasthesiol Intensivmed Notfallmed Schmerzther 46:756–759. doi:10.1055/s-0031-1297184

    Article  PubMed  Google Scholar 

  17. Volpicelli G, Elbarbary M, Blaivas M et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591. doi:10.1007/s00134-012-2513-4

    Article  PubMed  Google Scholar 

  18. Weber SU, Kim S‑C (2014) The right supraclavicular ultrasound view for real-time ultrasound-guided definite placement of a central venous catheter with a microconvex transducer. Eur J Anaesthesiol 31:173–174. doi:10.1097/EJA.0b013e3283642ae7

    Article  PubMed  Google Scholar 

  19. Wu S, Ling Q, Cao L et al (2013) Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology 118:361–375. doi:10.1097/ALN.0b013e31827bd172

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    S. U. Weber, A. Breuer & S.-C. Kim

Authors
  1. S. U. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Breuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S.-C. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. U. Weber.

Ethics declarations

Interessenkonflikt

S. U. Weber, A. Breuer und S.-C. Kim geben an, dass kein Interessenkonflikt besteht.

Für diese prospektive sonografischen Studie erfolgte eine Genehmigung durch die Ethikkommission der Rheinischen Friedrich-Wilhelms-Universität (Lfd. Nr. 274/12).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weber, S.U., Breuer, A. & Kim, SC. Darstellbarkeit der Vena cava superior im rechten supraklavikulären Schallfenster. Anaesthesist 65, 190–197 (2016). https://doi.org/10.1007/s00101-016-0146-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-016-0146-7

Schlüsselwörter

Keywords

Search

Navigation