Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students

Luisa Jabour Pazeli,Bernardo Costa Lemos,Marinna Marques Rodrigues Saliba,Maurício Dutra Costa,Pedro Andrade Mello,Rosimary Souza Vicentino,José Muniz Pazeli,Ana Luisa Silveira Vieira

doi:10.1186/s13089-018-0115-2

Luisa Jabour Pazeli, Bernardo Costa Lemos

Open Access

https://doi.org/10.1186/s13089-018-0115-2

Copy DOI

Abstract

ObjectivesTo show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US).Materials and methodsSix medical students without experience with US were given 4 h of theoretical–practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients. They also simulated a puncture of the IJV at a demarcated point, where a TT was theoretically performed.ResultsAdequate images were obtained from 95% of the patients; the IJV, on the right side, was more commonly found in the anterolateral position in relation to the CCA (38%). On the left side, the most commonly position observed was the anterior (36%). The caliber of the IJV relative to the CCA greatly varied. The success rate in the IJV puncture simulation, observed with US, by the TTs was 55%.ConclusionThe training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.

Highlights

Central venous access is the cannulation of a central vein via percutaneous puncture [1]
Adequate images were obtained from 95% of the patients; the internal jugular vein (IJV), on the right side, was more commonly found in the anterolateral position in relation to the common carotid artery (CCA) (38%)
The training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum

Summary

Introduction

Central venous access is the cannulation of a central vein via percutaneous puncture [1]. It is indicated in certain medical situations such as the hemodynamic monitoring of critical ill patients and the infusion of medications, parenteral nutrition, or hemodialysis [2]. Central puncture is typically performed at the jugular, subclavian, or femoral vein [3]. The internal jugular vein (IJV) is a common site, but recent data show that subclavian puncture is associated with lower rates of infection and thrombosis [4]. Puncture of a central vein is performed as the “blind” insertion of a needle following anatomical landmarks [5]. Puncture of the IJV for central venous

Objectives

Methods

Results

Discussion

Conclusion