{"id":2140,"date":"2020-02-27T00:00:00","date_gmt":"2020-02-26T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/santral-venoz-kateterin-yerini-dogrulamada-basitlestirilmis-ultrasonografi-teknigi-arizona-acil-servislerinde-acil-usg-kullanimi\/"},"modified":"2022-04-06T16:39:32","modified_gmt":"2022-04-06T13:39:32","slug":"santral-venoz-kateterin-yerini-dogrulamada-basitlestirilmis-ultrasonografi-teknigi-arizona-acil-servislerinde-acil-usg-kullanimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/santral-venoz-kateterin-yerini-dogrulamada-basitlestirilmis-ultrasonografi-teknigi-arizona-acil-servislerinde-acil-usg-kullanimi\/","title":{"rendered":"Santral ven\u00f6z kateterin yerini do\u011frulamada basitle\u015ftirilmi\u015f ultrasonografi tekni\u011fi & Arizona Acil Servislerinde Acil USG Kullan\u0131m\u0131"},"content":{"rendered":"\r\n

Sean P. Wilson ve arkada\u015flar\u0131n\u0131n Ocak 2012 ve May\u0131s 2015 aras\u0131nda Kaliforniya \u00dcniversitesinde yapt\u0131klar\u0131 ve Ocak 2017\u2019de World Journal of Emergency Medicine dergisinde yay\u0131mlanan prospektif \u00e7al\u0131\u015fmada (World J Emerg Med, Vol 8, No 1, 2017\u00a0doi:\u00a0\u00a010.5847\/wjem.j.1920-8642.2017.01.004<\/a>) supradiyafragmatik olarak yerle\u015ftirlen santral ven\u00f6z kateterlerin (SVK) yerinin do\u011frulanmas\u0131nda ultrasonografi (USG) kullan\u0131m\u0131 ile direk grafi (DG) kullan\u0131m\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131rmas\u0131 yap\u0131lm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fmada USG ile SVK yerinin tespiti i\u00e7in tek pencereden g\u00f6r\u00fcnt\u00fcleme al\u0131nd\u0131\u011f\u0131 kaydedilmi\u015f. SVK yerle\u015ftirildikten sonra 1-5 Mhz sekt\u00f6r prob kullan\u0131larak sa\u011f atriyumu g\u00f6r\u00fcnt\u00fcleyecek \u015fekilde uygun pencere (subksifoid, parasternal veya apikal) a\u00e7\u0131larak B-modda inceleme yap\u0131lm\u0131\u015f. \u0130nceleme esnas\u0131nda SVK l\u00fcmenine 5 ml SF (% 0,9 NaCl sol\u00fcsyonu) h\u0131zl\u0131 olarak verilmi\u015f ve sa\u011f atriyumda meydana gelen t\u00fcrb\u00fclan ak\u0131m g\u00f6r\u00fcnt\u00fclenmeye \u00e7al\u0131\u015f\u0131lm\u0131\u015f. \u00c7al\u0131\u015fmada bu tekni\u011fin kateter yerini do\u011frulamaktaki rol\u00fcne ek olarak bu do\u011frulaman\u0131n ald\u0131\u011f\u0131 s\u00fcre de kaydedilmi\u015f. Daha sonra t\u00fcm hastalara direk grafi \u00e7ekilerek USG\u2019nin do\u011frulu\u011fu test edilmi\u015f. Ayr\u0131ca direk grafi i\u00e7in gereken s\u00fcrede kaydedilerek USG ile kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

78 hastan\u0131n kat\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmada USG kateter yerini tespit etmede % 86,8 (%95 Cl %77,1-%93,5) duyarl\u0131 ve %100 (%95 Cl %15,8-%100) \u00f6zg\u00fcl olarak bulunmu\u015f. \u00c7al\u0131\u015fmaya kat\u0131lan hastalardan 2 tanesinde kateterin yanl\u0131\u015f yerle\u015fimli oldu\u011fu tespit edilmi\u015f ve USG de bu hastalarda yanl\u0131\u015f yerle\u015fimi do\u011frulam\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

S\u00fcre kar\u015f\u0131la\u015ft\u0131rmas\u0131nda USG\u2019de ortalama s\u00fcre 27,6 dakika, DG\u2019de ortalama s\u00fcre 37,6 dakika olarak hesaplanm\u0131\u015f ve direk grafide ortalama 10 dakika gecikme ya\u015fand\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f (p=0,07).<\/p>\r\n\r\n\r\n\r\n

Tart\u0131\u015fmada makale yazarlar\u0131 kateter yerinin do\u011frulanmas\u0131 i\u00e7in direk grafinin alt\u0131n standart olarak kullan\u0131ld\u0131\u011f\u0131n\u0131, daha \u00f6nceden baz\u0131 ba\u015fka \u00e7al\u0131\u015fmalarda kontrast madde kullan\u0131larak SVK yerinin USG ile birka\u00e7 farkl\u0131 pencereden do\u011fruland\u0131\u011f\u0131n\u0131; kendi tarifledikleri y\u00f6ntemde ise SF kullan\u0131lmas\u0131 ile malzemeye ula\u015fma sorununun ve tek pencereden g\u00f6r\u00fcnt\u00fcleme ile de tekni\u011fin komplike olma sorununun \u00e7\u00f6z\u00fcld\u00fc\u011f\u00fcn\u00fc savunmu\u015flar. USG\u2019nin SVK yerinin do\u011frulanmas\u0131 i\u00e7in yeterli bir teknik oldu\u011funu hatta DG ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda s\u00fcre kazan\u0131m\u0131 olmas\u0131 nedeniyle kullan\u0131m\u0131n\u0131n daha avantajl\u0131 olaca\u011f\u0131n\u0131 belirtmi\u015fler.<\/p>\r\n\r\n\r\n\r\n

Yine de \u00e7al\u0131\u015fmada yer alan hasta say\u0131s\u0131n\u0131n az olmas\u0131, \u00f6zellikle yanl\u0131\u015f yerle\u015fimli kateter say\u0131s\u0131n\u0131n sadece 2 olarak tespit olmas\u0131 USG\u2019nin de bu 2 hastay\u0131 da yakalam\u0131\u015f olmas\u0131 nedeniyle yanl\u0131\u015f pozitif hi\u00e7 vakan\u0131n bulunmay\u0131\u015f\u0131n\u0131 \u00e7al\u0131\u015fman\u0131n zay\u0131f noktalar\u0131ndan biri olarak belirtmi\u015f ve ileri \u00e7al\u0131\u015fmalar\u0131n gereklili\u011fini hat\u0131rlatm\u0131\u015flar.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fman\u0131n klinik prati\u011fimize katk\u0131s\u0131 ve yazar\u0131n yorumu:<\/strong><\/em>\u00a0<\/p>\r\n\r\n\r\n\r\n

Pn\u00f6motoraks bu hastalarda \u00f6nemli bir komplikasyon olmakla birlikte \u00e7al\u0131\u015fman\u0131n amac\u0131 olmad\u0131\u011f\u0131 i\u00e7in de\u011ferlendirilmeye al\u0131nmam\u0131\u015f ama giri\u015f\u00a0k\u0131sm\u0131nda belirtilmi\u015f. \u00c7al\u0131\u015fmaya dahil edilseydi klinik prati\u011fe daha iyi yans\u0131yabilirdi \u00e7\u00fcnk\u00fc radyografi sadece yer do\u011frulamak i\u00e7in kullan\u0131lm\u0131yor. Onun d\u0131\u015f\u0131nda, USG ile do\u011frulaman\u0131n “ortalama 27 dk.” gibi uzun bir s\u00fcre almas\u0131n\u0131n sebebi ise cihaz\u0131 a\u00e7\u0131l\u0131\u015ftan son do\u011frulamaya kadar olan s\u00fcreyi almalar\u0131 sebebiyle uzun s\u00fcrm\u00fc\u015f. Zaten bu hastalarda giri\u015fimsel i\u015filemlerin USG e\u015fli\u011finde yap\u0131ld\u0131\u011f\u0131n\u0131 kabul edersek, bu s\u00fcrenin asl\u0131nda daha k\u0131sa olmas\u0131 gerekiyor.\u00a0Bize faydas\u0131 olan k\u0131sm\u0131na gelince, stabil olmayan hastalar icin radyoloji \u00fcnitesine gitmek zor. Portabl grafiler de bazen saatleri bulabiliyor. USG ciddi anlamda bu hastalarda bize zaman kazand\u0131rabilir.\u00a0<\/p>\r\n\r\n\r\n\r\n

Arizona Acil Servislerinde Acil USG Kullan\u0131m\u0131<\/strong><\/h2>\r\n\r\n\r\n\r\n

Journal\u00a0of Ultrasound Medicine dergisinde \u015eubat 2017\u2019de yay\u0131mlanan makalede (J Ultrasound Med. 2017 Feb 2. doi: 10.7863\/ultra.16.05064.<\/a>)\u00a0<\/em>Amini R. Ve arkada\u015flar\u0131 Arizona eyaleti i\u00e7erisindeki acil servisleri akademik aciller ve akademik olmayan aciller olarak ikiye ay\u0131rarak akademik olmayan diye tan\u0131mlad\u0131klar\u0131 acil servislere anket g\u00f6ndermi\u015f ve ald\u0131klar\u0131 yan\u0131tlar\u0131 de\u011ferlendirmi\u015fler.<\/p>\r\n\r\n\r\n\r\n

\u00a070 akademik olmayan merkezden 58 tanesi anketi tamamlam\u0131\u015f (%83). En \u00e7ok kullan\u0131lan 3 USG y\u00f6nteminin travma i\u00e7in USG, kardiyak USG ve giri\u015fimsel USG (kateter i\u00e7in) oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f. Acil servislerin % 75\u2019inde yap\u0131lan ultrasonografik incelemeler hi\u00e7 bir kalite kontrol uygulamas\u0131na tabi tutulmam\u0131\u015f ve yine acil servislerin % 50\u2019sinde g\u00f6r\u00fcnt\u00fcleri kaydetmek i\u00e7in gerekli olan sistemlerin bulunmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f. Acil servislerin % 83\u2019\u00fcn\u00fcn Amerikan Acil Hekimleri Birli\u011fi\u2019nin (ACEP) tan\u0131mlad\u0131\u011f\u0131 Klinik Ultrasonografi Akreditasyon Program\u0131n\u0131n faydal\u0131 oldu\u011funu d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fc tespit edilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

Makale sonucunda ara\u015ft\u0131rmac\u0131lar ultrasonografi cihaz\u0131n\u0131n \u00e7o\u011fu acil serviste ula\u015f\u0131labilir oldu\u011fu fakat kullan\u0131c\u0131lar\u0131n yeterince e\u011fitimli olmad\u0131\u011f\u0131 yarg\u0131s\u0131na varm\u0131\u015flar.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fman\u0131n klinik prati\u011fimize katk\u0131s\u0131 ve yazar\u0131n yorumu<\/strong>:<\/em><\/p>\r\n\r\n\r\n\r\n

\u00dclkemizde de benzer \u015fekilde asistan e\u011fitiminin de verildi\u011fi acil servisler oldu\u011fu gibi e\u011fitim verilmeyen, devlet hastanesi acil servislerinin akademik olmayan acil servis s\u0131n\u0131flamas\u0131 i\u00e7inde yer alabilece\u011fini d\u00fc\u015f\u00fcnmek yanl\u0131\u015f olmayacakt\u0131r. Yine bu acil servislerin bir k\u0131sm\u0131nda ultrasonografi cihaz\u0131na eri\u015fimin oldu\u011fu fakat klinisyenlerin ultrasonografi e\u011fitimlerinin yeterli olmamas\u0131 nedeniyle cihazlar\u0131n yeterli kullan\u0131lmad\u0131\u011f\u0131n\u0131 savunmak yanl\u0131\u015f olmayacakt\u0131r. Bu do\u011frultuda acil servis hekimlerinin ultrasonografi e\u011fitimlerinin artt\u0131r\u0131lmas\u0131 gereklili\u011fi a\u015fikard\u0131r.\u00a0<\/p>\r\n","protected":false},"excerpt":{"rendered":"

Sean P. Wilson ve arkada\u015flar\u0131n\u0131n Ocak 2012 ve May\u0131s 2015 aras\u0131nda Kaliforniya \u00dcniversitesinde yapt\u0131klar\u0131 ve Ocak 2017\u2019de World Journal of Emergency Medicine…<\/p>\n","protected":false},"author":1500,"featured_media":2353,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,12],"tags":[10027,10028],"class_list":["post-2140","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-girisimsel-usg","tag-kateter"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1500"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2140"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2140\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2353"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2140"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2140"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}