<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092024000600469</article-id>
<article-id pub-id-type="doi">10.35366/119234</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Nueva propuesta de acceso subclavio guiado por ultrasonido en México: acceso supraclavicular]]></article-title>
<article-title xml:lang="en"><![CDATA[New proposal for ultrasound-guided subclavian access in Mexico: supraclavicular access]]></article-title>
<article-title xml:lang="pt"><![CDATA[Nova proposta de acesso subclávio guiado por ultrassom no México: acesso supraclavicular]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramírez Toral]]></surname>
<given-names><![CDATA[Julissa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montelongo]]></surname>
<given-names><![CDATA[Felipe de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tapia Velasco]]></surname>
<given-names><![CDATA[Rafael]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Galindo Ayala]]></surname>
<given-names><![CDATA[Jonathan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Trujillo Martínez]]></surname>
<given-names><![CDATA[Miguel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez Rosas]]></surname>
<given-names><![CDATA[Ana Itzel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Instituto de Salud del Estado de México Hospital General «Las Américas» de Ecatepec]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital General de Zona Num. 197 ]]></institution>
<addr-line><![CDATA[Texcoco Estado de México]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital General de Zona con Medicina Familiar Núm. 7 ]]></institution>
<addr-line><![CDATA[Cuautla Morelos]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>6</numero>
<fpage>469</fpage>
<lpage>472</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000600469&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000600469&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000600469&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  El acceso venoso central es uno de los procedimientos más utilizados en el área de la salud, es por ello que casi 90% de los pacientes que ingresan a la Unidad de Cuidados Intensivos ameritan un acceso venoso central, y en algunos casos con urgencia, como la vena subclavia o yugular que frecuentemente se coloca guiado por referencias anatómicas. Además, la introducción de la ultrasonografía Point-of-Care para guiar los accesos vasculares se ha convertido en una herramienta para la realización del procedimiento en el área médica de forma segura. Es por ello, que el propósito de nuestra investigación es proponer el abordaje supraclavicular guiado por ultrasonido, como una alternativa en pacientes críticos.  Material y métodos:  Estudio piloto, prospectivo, transversal y analítico realizado en pacientes de la Unidad de Cuidados Intensivos del Hospital General «Las Américas» del Instituto de Salud del Estado de México, con uso del ultrasonido Siemens Acuson Freestyle inalámbrico con transductor lineal 7-13 MHz y catéter venoso central trilumen o bilumen de 7 French de diámetro y de 20 centímetros de longitud.  Resultados:  El éxito de colocación de catéter venoso central supraclavicular guiado por ultrasonido fue de 86.66%, con media de 40 segundos desde la inserción en la piel hasta la colocación de la guía metálica dentro de la vena subclavia. Se registraron limitantes en la colocación tales como falla de la instalación en 13% por variantes anatómicas y presencia de trombos en la vena subclavia, y con complicaciones como punción arterial en 10% y neumotórax en 3% de la muestra de 30 pacientes.  Conclusiones:  La colocación para el acceso venoso central supraclavicular guiado por ultrasonido es una técnica alternativa que proponemos para la realización en pacientes en el área crítica.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Central venous access is one of the most used procedures in the health area, that is why almost 90% of patients admitted to the intensive care unit require a central venous access, and in some cases with urgency such as the subclavian or jugular vein, which is frequently placed guided by anatomical references. In addition, the introduction of Point-of-care ultrasonography to guide vascular accesses, allows it to be a tool to perform the procedure in the medical area in a safe way. Therefore, the purpose of our research is to propose the ultrasound-guided supraclavicular approach as an alternative in critically ill patients.  Material and methods:  A pilot, prospective, transversal and analytical study was carried out in patients of the intensive care unit of the Hospital General «Las Américas» of the Instituto de Salud del Estado de México, with the use of wireless Siemens Acuson Freestyle ultrasound with linear transducer 7-13 MHz and trilumen or bilumen central venous catheter of 7 French diameter and twenty centimeters in length.  Results:  The success of supraclavicular central venous catheter placement guided by ultrasound was 86.66%, with an average of 40 seconds from insertion into the skin to placement of the guidewire into the subclavian vein. There were limitations in placement such as installation failure in 13% due to anatomical variants and presence of thrombus in the subclavian vein, and complications such as arterial puncture in 10% and pneumothorax in 3% of the sample of 30 patients.  Conclusions:  Placement for supraclavicular central venous access guided by ultrasound is an alternative technique that we propose for patients in the critical area.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  O acesso venoso central é um dos procedimentos mais utilizados na área da saúde, razão pela qual quase 90% dos pacientes internados na unidade de terapia intensiva necessitam de um acesso venoso central e, em alguns casos, com urgência, como a veia subclávia ou jugular, que frequentemente é colocado guiado por referências anatômicas. Além disso, a introdução da ultrassonografia no local de atendimento para guiar acessos vasculares fornece uma ferramenta para a realização do procedimento na área médica com segurança. Portanto, o objetivo de nossa pesquisa é propor a abordagem supraclavicular guiada por ultrassom como uma alternativa em pacientes em estado crítico.  Material e métodos:  Foi realizado um estudo piloto, prospectivo, transversal e analítico em pacientes da unidade de terapia intensiva do Hospital Geral «Las Américas» do Instituto de Saúde do Estado do México, usando o ultrassom sem fio acuson freestyle da Siemens com transdutor linear de 7-13 mHz e cateter venoso central de trilúmen ou blilúmen de 7 french de diâmetro e 20 centímetros de comprimento.  Resultados:  A taxa de sucesso da colocação do cateter venoso central supraclavicular guiada por ultrassom foi de 86.66%, com um tempo médio de 40 segundos desde a inserção na pele até a colocação da guia metálica no interior da veia subclávia. Foram relatadas limitações na colocação, como falha na instalação em 13% devido a variantes anatômicas e presença de trombo na veia subclávia, e complicações como punção arterial em 10% e pneumotórax em 3% da amostra de 30 pacientes.  Conclusões:  A colocação de acesso venoso central supraclavicular guiado por ultrassom é uma técnica alternativa que propomos para ser realizada em pacientes na área crítica.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[catéter venoso central]]></kwd>
<kwd lng="es"><![CDATA[acceso supraclavicular]]></kwd>
<kwd lng="es"><![CDATA[ultrasonido]]></kwd>
<kwd lng="es"><![CDATA[vena subclavia]]></kwd>
<kwd lng="es"><![CDATA[referencias anatómicas]]></kwd>
<kwd lng="en"><![CDATA[central venous catheter]]></kwd>
<kwd lng="en"><![CDATA[supraclavicular access]]></kwd>
<kwd lng="en"><![CDATA[ultrasound]]></kwd>
<kwd lng="en"><![CDATA[subclavian vein]]></kwd>
<kwd lng="en"><![CDATA[anatomical references]]></kwd>
<kwd lng="pt"><![CDATA[cateter venoso central]]></kwd>
<kwd lng="pt"><![CDATA[acesso supraclavicular]]></kwd>
<kwd lng="pt"><![CDATA[ultrassom]]></kwd>
<kwd lng="pt"><![CDATA[veia subclávia]]></kwd>
<kwd lng="pt"><![CDATA[referências anatômicas]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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