RU-2861538-C1 - METHOD FOR CREATING CENTRAL VENOUS ACCESS

RU2861538C1RU 2861538 C1RU2861538 C1RU 2861538C1RU-2861538-C1

Abstract

FIELD: medicine; vascular surgery. SUBSTANCE: invention can be used to create central venous access. Determining the site of anatomical confluence of the transverse cervical vein and the external jugular vein using ultrasound scanning. Performing vein puncture with a needle with an attached J-shaped guidewire and implanting a tunneled central venous catheter. EFFECT: avoiding the placement of femoral tunneled central venous catheters due to the risk of infection and thrombosis, placing the catheter on both the right and left sides, by using an anatomically advantageous and less risky puncture site. 1 cl, 3 dwg, 3 ex

Inventors

Shakhov Nikolaj Leonidovich
Lysenko Maryana Anatolevna
Dushkin Aleksandr Dmitrievich
Trushkin Ruslan Nikolaevich
Frolova Nadiya Fyaatovna
Bogodarov Mikhail Yurevich
Berdinskij Vitalij Andreevich
KISELEV ALEKSEJ SERGEEVICH
Evdokimova Alina Andreevna

Dates

Publication Date: 20260505
Application Date: 20250618

Claims (1)

A method for installing a tunneled central venous catheter under ultrasound navigation, including implantation of a catheter in the jugular vein, characterized in that, using longitudinal ultrasound scanning, the location of the anatomical junction of the transverse vein of the neck and the external jugular vein is determined, at which point a vein is punctured with a needle with a connected J-shaped guide and the tunneled central venous catheter is implanted.

Description

The invention relates to the field of medicine and can be used in cardiovascular surgery for catheterization of the central vein for the purpose of creating central venous access, in particular during hemodialysis. There are three main forms of access for chronic hemodialysis: native arteriovenous fistula (AVF), synthetic vascular graft (SVP), and tCVC [1]. According to KDOQI guidelines, it is considered appropriate to have arteriovenous access (AVF or SVP) in a patient requiring hemodialysis, however, when clinically justified, a tunneled central venous catheter (tCVC) should be used for short-term or long-term use [1]. The site for insertion of the tCVC can be selected from the following list, in order of preference [1]: internal jugular vein; external jugular vein; femoral vein; subclavian vein; iliac vein. If tCVC placement in the jugular veins is not feasible, femoral vein placement is recommended. This location is less preferred; femoral tCVC placement is recommended only for short-term use and is not recommended for obese patients due to the increased risk of infection and thrombosis [1, 2, 3]. Catheter placement in the right or left subclavian veins is not recommended, as vascular stenosis often develops in this location following tCVC placement [1]. Given the development of adverse events and vascular complications following the placement of tDCS in standard venous access sites, we set the goal of developing a method for creating central venous access at a new anatomical vascular site. The most anatomically and physiologically convenient access point to the central veins is the confluence of the transverse cervical vein and the external jugular vein. Access can be created from either the right or left side. The closest technical approach to the proposed method is a method of catheterization of the internal jugular vein via a central access under ultrasound navigation (patent RU 2 471 516 C. Patent owner: Federal State Institution "Nizhny Novgorod Research Institute of Traumatology and Orthopedics" of the Ministry of Health and Social Development of the Russian Federation. Author: Dmitry Vladislavovich Zabolotsky). However, this method pertains to the field of anesthesiology and resuscitation and does not involve the placement of a tunneled central venous catheter. Methods of ultrasound-guided catheterization of the internal jugular vein for the installation of central venous catheters for hemodialysis are widely known and described [4,5]. However, all of these methods can lead to the development of stenosis and occlusion of the subclavian vein. With occlusion of the internal jugular vein, compensatory dilation of the transverse cervical vein and external jugular vein is observed. Variants with dilation of only the transverse cervical vein or only the external jugular vein also occur. The confluence of these veins has the largest diameter. Normally, the external jugular vein and transverse cervical vein have a diameter of approximately 2.5-3 mm. With occlusion of the internal jugular vein, the diameters of these veins increase to 5 mm, and in the angular region to 10-12 mm. This method is carried out as follows: A linear transducer with an ultrasound emission frequency of 7.5 MHz is used. The ultrasound machine is positioned on the side opposite the procedure, with its screen directly in front of the operator. Catheterization is performed using aseptic and antiseptic techniques. The supraclavicular region is scanned bilaterally (Fig. 1). Visualization of the vascular bundle is achieved using various transducer movements: sliding, tilting, rocking, and rotation. Based on a combination of factors, namely vessel shape and size, pulsation, compressibility, inspiratory collapse, and relative position, the angle (location) of confluence of the transverse cervical vein and external jugular vein is identified. In the absence of anatomical features, the right side is preferred, as the catheter is positioned along an arc to the level of the right atrium without additional angles (Fig. 2). This contrasts with the left side, where the catheter forms two angles and the presence of the main lymphatic duct must also be taken into account. Following the transverse scanning of the vascular bundle described above, the transducer is deployed for longitudinal vein puncture. The transducer should be positioned directly over the vein and at a 45° angle to the body surface in the supraclavicular region. Using a small-diameter needle, i.e., the first needle, a puncture is made in the skin at the lateral edge of the transducer and advanced toward the confluence of the veins strictly along the transducer's midline, monitoring tissue displacement or the advancement of the needle itself and injecting a local anesthetic solution. Then, along the same trajectory, the second, i.e., the "working" needle is advanced to the confluence of the veins. Entry of the "working" needle into the vein is confirmed by blood aspiration. The bev