RIGHT INTERNAL JUGULAR VEIN PUNCTURE USING RESPIRATORY JUGULAR VENODILATION AS A GUIDE

Abstract

S67 The right internal jugular vein (RIJV) is widely used for central venous cannulation in anesthetized patients. Various approaches using external anatomical landmarks or ultrasound-guidance have been reported. We describe a new approach using respiratory jugular venodilation as a guide to localize the RIJV, which is observed in many of the anesthetized patients under controlled ventilation. We evaluated the success rate and the incidence of carotid artery (CA) puncture in this new approach. Methods: After IRB approval, 123 adult patients (average age 61 +/- 13 years: 80 men, 43 women) undergoing general anesthesia and RIJV cannulation were prospectively studied. After induction of general anesthesia and endotracheal intubation, patients were positioned 15[degree sign] head-down with the head rotated 30[degree sign] to the left. The right CA was palpated at the level of the cricoid cartilage, then the respiratory jugular venodilation was identified lateral to the CA. A seeking puncture was performed with a 23-gauze needle, aiming at the center of the venodilation at a 45[degree sign] angle against the skin in the sagittal direction. When the RIJV venodilation could not be identified, the puncture was performed 5 mm lateral to the CA palpation. When the first attempt failed to localize the RIJV, the following punctures were performed 3-5 mm either medial or lateral to the preceding needle pass. The number of attempts for RIJV access and the CA puncture rate were investigated. Results: Eight anesthesiologists including 3 residents participated in the study. The RIJV dilation, which is identified as a skin elevation during the inspiratory period of ventilation was visible in 99 of 123 patients (80.5%). In this group of patients, the RIJV was successfully localized on the first attempt in 84 patients (84.8%), and no patient required more than 4 needle passes, while CA puncture occurred in 4 patients (4.0%). (Table 1)Table 1: Results of RIJV punctureDiscussion: The most significant finding of our study is that RIJV access was achieved on the first attempt in 84.8% of patients whose respiratory jugular venodilation was used to guide the puncture. This rate is comparable to that obtained by ultrasound-guided cannulation [1,2]. The incidence of CA puncture in this group of patients was as low as 4.0%. These results suggest that respiratory jugular venodilation, when identifiable, can be used as the primary landmark for RIJV cannulation in anesthetized and mechanically ventilated patients.