婴幼儿中心静脉置管内容置管途径置管途径7颈内静脉1.Highapproach,midwaybetweenmastoidprocessandsternalnotch.2,3.Middleapproachusingapexofmusculartriangleorcricoidcartilage.4.Lowapproachusingjugularnotch.5.Lateralapproachtosubclavianvenipuncture.颈内静脉穿刺入路15穿刺方法171819202122锁骨下静脉锁骨下静脉股静脉股静脉脐静脉脐静脉置管外周导入中心静脉置管外周导入中心静脉置管经胸直接心腔内置管超声辅助技术超声多普勒血流探测器anuncommoninternalveinlocalization.颈内静脉与颈动脉常呈部分或全部重叠误入颈动脉高达10%-15%Ultrasoundimage先心病和其它大手术、重症监护治疗或某些慢性疾病的婴幼儿常需放置中心静脉导管新鲜尸体解剖39例:心包反摺横跨上腔静脉否则颈内静脉与颈动脉重叠的机会增大导管进入对側头臂静脉约为5%-20%塞管1例、导管末段细菌培养阳性3例超声波血管定位技术可以提高婴幼儿中心静脉置管的成功率。在心肺转流的复温期置入各种导管静脉与体表标志相对恆定Two-dimensionalultrasoundviewoftheinternaljugularvein(largercircle,aboveandtotherightofthesmallercarotidartery).最常见的有血栓形成与感染颈内静脉与颈动脉常呈部分或全部重叠误入颈动脉高达10%-15%PICC使VLBW患儿顺利完成过度导管进入对側头臂静脉约为5%-20%癌症病人经外周置入中心静脉导管（PICC）的并发症约为10.即使静脉壁穿孔，也无心包填塞危险ThetipoftherightinternaljugularcatheterisintheSVC,6mmabovetheRA..最佳置管深度颈内静脉和锁骨下静脉右侧颈内静脉/锁骨下静脉置管深度47Postoperativechestradiographwiththetipofarightinternaljugularveincatheterinthemid-superiorvenacava.ThecarinaisnotalandmarkforcentralvenouscatheterplacementinneonatesPediatricAnesthesia200717:968–971Age:postconceptionalage(gestationalageinweeks+weeksafterdelivery);distance:longitudinaldistancebetweenthecarinaandPR,positivedistancemeansthePRisabovethecarinaandnegativedistancemeansthePRisbelowthecarina.PR,pericardialreflection;PediatricAnesthesia200717:968–971经股静脉中心静脉导管尖端最佳深度cm＝0.45×kg+8.13R2＝0.84.常规摄片以证实导管位置，然后才能开始使用化疗药物或静脉高营养3例导管破裂,5例导管培养+Themajorityofinternaljugularveinsareatleastpartiallycoveringtheinternaljugularveins.PR,pericardialreflection;癌症病人经外周置入中心静脉导管（PICC）的并发症约为10.否则颈内静脉与颈动脉重叠的机会增大Figuresaregiveninpercent.经食道超声心动图技术有助于术中即刻观察到中心静脉导管的位置Ultrasoundimage3例导管破裂,5例导管培养+anuncommoninternalveinlocalization.BJA2004,92(1):75-77.塞管1例、导管末段细菌培养阳性3例Age(months)Anatomicrelationshipbetweentheinternaljugularveinandthecarotidarteryinpreschoolchildren–anultrasonographicstudy.1998,12:523-526导管进入对側头臂静脉约为5%-20%55RothB.Anatomicrelationshipbetweentheinternaljugularv