Efficacy of ultrasound-prepositioned four-point method for right internal jugular vein catheterization in parturients at high risk of bleeding

Abstract

Objective To evaluate the efficacy of ultrasound-prepositioned four-point method for right internal jugular vein (IJV) catheterization in the parturients at high risk of bleeding. Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱparturients diagnosed as having pernicious placenta previa, aged 25-38 yr, weighing 60-90 kg, scheduled for elective cesarean section under general anesthesia, were divided into 2 groups (n=40 each) using a random number table method: real-time ultrasonic guidance group (group UG) and ultrasound-prepositioned four-point method group (group UF). In group UG, the right IJV catheterization was performed under real-time ultrasound guidance: moving the ultrasonic probe to make the mid-line of the cross section image of the right IJV overlap with the mid-line of the ultrasonic display screen, and the intersection of the mid-line of the IJV and the horizontal line of the annular cartilage was selected as the puncture point.In group UF, the right IJV catheterization was performed by using ultrasound-prepositioned four-point method as follows: moving the ultrasonic probe to make the midline of the right IJV cross-sectional images overlap with the midline of the ultrasound display screen, and marking the skin where the midpoint of the probe′s long-axis was located as point A; transversely moving the probe to the inside so that the tangent line of its inner edge overlapped with the midline of the ultrasonic display screen, marking the skin where the midpoint of the probe′s long-axis was located as point B (the puncture site); at the proximal cardiac end of the right IJV, making point C at 2 cm from point B, and making point D (the indicator point, direction of the puncture needle) at 2 cm from point A. After local infiltration anesthesia was performed in point B, the puncture needle was inserted towards the point D. The success rate of puncture, success rate of catheterization, catheterization operation time and complications such as hematoma, intravascular catheter insertion or hemopneumothorax were recorded. Results The success rate of total catheterization was 100% in two groups.Compared with group UG, the catheterization operation time was significantly shortened (P 0.05). Conclusion Compared with real-time ultrasound guidance, ultrasound-prepositioned four-point method produces better efficacy when used for the right IJV catheterization in the parturients at high risk of bleeding. Key words: Ultrasonography; Catheterization, central venous; Cesarean section