nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2022-11-1-59-66nmp-1340Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESКатетеризация подключичной вены с использованием ультразвуковой навигации в педиатрической практикеUltrasound-Guided Central Vein Catheterization in Pediatricshttps://orcid.org/0000-0001-7625-2771ЛеонтьевМ. А.LeontievM. A.

Леонтьев Михаил Александрович - кандидат медицинских наук, врач анестезиолог-реаниматолог, отделение анестезиологии-реанимации.

119049, Москва, 4-й Добрынинский переулок, д. 1/9

Mikhail A. Leontiev - Candidate of Medical Sciences, anesthesiologist-resuscitator.

1/9, 4th Dobryninsky lane, Moscow, 119049

miwa_leontev@mail.ruhttps://orcid.org/0000-0001-7342-6254КравчукС. В.KravchukS. V.

Кравчук Сергей Владимирович - заведующий отделением анестезиологии-реанимации, врач анестезиолог-реаниматолог.

119049, Москва, 4-й Добрынинский переулок, д. 1/9

Sergey V. Kravchuk - Head, Department of Anesthesiology and Resuscitation, anesthesiologist-resuscitator.

1/9, 4th Dobryninsky lane, Moscow, 119049

anesthmdgkb@gmail.comhttps://orcid.org/0000-0003-3637-9895ВодоваА. В.VodovaA. V.

Водова Анастасия Васильевна – студентка.

117997, Москва, ул. Островитянова, д. 1

Anastasia V. Vodova – Student.

1 Ostrovityanova St., Moscow, 117997

ms.vodova@mail.ruГБУЗ Морозовская детская городская клиническая больница ДЗМРоссияMorozov Children’s Municipal Clinical Hospital of the Moscow City Health DepartmentRussian FederationФГАОУ ВО Российский национальный исследовательский медицинский университет им. Н.И. Пирогова МЗ РФРоссияPirogov Russian National Research Medical UniversityRussian Federation2022080420221115966Copyright © Леонтьев М.А., Кравчук С.В., Водова А.В., 20222022Леонтьев М.А., Кравчук С.В., Водова А.В.Leontiev M.A., Kravchuk S.V., Vodova A.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1340

РЕЗЮМЕ В статье рассмотрены актуальные методики катетеризации подключичной вены в контексте поиска оптимальной техники, которая может быть использована в рутинной клинической практике специалистами интенсивной терапии педиатрического профиля.

ЦЕЛЬ Сравнить эффективность и безопасность катетеризации подключичной вены надключичным доступом под ультразвуковым (УЗ) контролем и подключичным доступом по анатомическим ориентирам у детей.

МАТЕРИАЛ И МЕТОДЫ Ретроспективный анализ результатов различных доступов при катетеризации подключичной вены у 3375 пациентов Морозовской больницы Москвы за 2019–2020 годы.

РЕЗУЛЬТАТЫ Количество попыток до успешной катетеризации было статистически значимо меньше в группе с использованием УЗ-контроля в сравнении с группой катетеризации по анатомическим ориентирам (1,2±0,4 против 2,6±1,3, p<0,0001); при установке центрального венозного катетера «вслепую» статистически значимо чаще, чем при катетеризации под УЗ-контролем, наблюдались осложнения в виде мальпозиции катетера (14% против 0%, p<0,0001), пункции артерии (1% против 0,8%, p<0,01) и пневмоторакса (1,6% против 0%, p<0,0001).

ВЫВОДЫ Мы рекомендуем методику катетеризации подключичной вены надключичным доступом под ультразвуковым контролем к широкому использованию в клинической практике ввиду ее высокой эффективности и безопасности.

ABSTRACT In this article the most relevant methods of subclavian vein catheterization were considered in order to find the optimal technique that can be used in routine clinical practice by pediatric intensive care physicians.

OBJECTIVE To compare the efficiency and safety of subclavian vein catheterization by supraclavicular access under ultrasound control and subclavian access by anatomical landmarks in children.

RESULTS The number of attempts for successful catheterization was statistically lower in ultrasound-control group compared to the anatomical landmarks group (1.2±0.4 vs. 2.6±1.3, p<0.0001); in the anatomical landmarks group such complications as catheter malposition (14% vs. 0), arterial puncture (5% vs. 1%) and pneumothorax (10% vs. 0) were observed more often than in the ultrasound group.

CONCLUSIONS We recommend catheterization of the subclavian vein by supraclavicular access under ultrasound control to be commonly used in clinical practice due to its high efficiency and safety.

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The authors declare that there are no conflicts of interest present.