Ultrasound assisted catheterization of internal jugular vein

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

Subclavian artery perforation and hemothorax after right internal jugular vein catheterization

Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study

Feasibility of the Use of Transesophageal Echocardiography as a Surface Probe for Puncturing and Catheterization of the Internal Jugular Vein: A Randomized Controlled Pilot Study

BackgroundUltrasound-guided internal jugular vein (IJV) catheterization has become a standard procedure as it yields a higher success rate and fewer mechanical complications compared with an anatomical landmark technique. There are several common methods for ultrasound guidance IJV catheterization, such as short-axis out-of-plane, long-axis in-plane and oblique axis in-plane, but these technologies are still developing. It is important to further study the application of different ultrasound-guided IJV puncture techniques and find an effective and safe ultrasound-guided puncture technique.MethodsA China randomized, open-label, parallel, single center, positive-controlled, non-inferiority clinical trial will evaluate 190 adult patients undergoing elective surgery and need right jugular vein catheterization. Study participants randomized in a 1:1 ratio into control and experimental groups. The control group will take the oblique axis in-plane method for IJV catheterization. The experimental group will take the Modified combined short and long axis method. The primary endpoint of the trial is the rate of one-time successful guidewire insertion without posterior wall puncture (PWP). Secondary endpoints are the number of needle insertion attempts, the total success rate, the procedure time, and mechanical complications.ConclusionThis randomized controlled trial will evaluate the effectiveness and safety of Modified combined short and long axis method and oblique axis in-plane method for right IJV catheterization in adult patients.

Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. Internal jugular vein catheterization is associated with a high rate of successful catheter placement. However, significant complications such as internal carotid artery (ICA) puncture, pneumothorax, vessel erosion, thrombosis, airway obstruction and infection can occur. The most common complication is ICA puncture. More recently a few cases of thyrocervical trunk pseudoaneurysm and fistula following internal jugular vein and subclavian vein catheterization attempts have been reported. Patients with renal failure who are on hemodialysis may have to undergo multiple catheter placements and vascular access interventions. This, along with their comorbid conditions, increases the risk of such complications. Here we report a patient on hemodialysis who developed transverse cervical artery pseudoaneurysm following an attempted right internal jugular vein catheterization. We report this case because of its rarity, to raise awareness of such a complication and to discuss different treatment options, in particular endovascular coil occlusion. A review of relevant literature is also presented.

Internal jugular vein (IJV) catheterization has become the preferred approach for temporary vascular access for hemodialysis. However, complications such as internal carotid artery puncture, vessel erosion, thrombosis, and infection may occur. We report a case of brachial plexus palsy due to compression by right subclavian artery pseudoaneurysm as a result of IJV catheterization in a patient who was under maintenance hemodialysis.

Vascular access is the key in successful management of chronic haemodialysis (HD) patients. Though native arteriovenous fistula (AVF) is considered the access of choice, many patients in our country initiate haemodialysis through central venous catheter (CVC). There is paucity of data on vascular access in haemodialysis patients from southern India. Aim of the present study was to review our experience of vascular access in Haemodialysis patients (both central venous catheters and arteriovenous fistula) and to assess its success rate and common complications. This prospective study was conducted between January 2014 and December 2014 in our institute. A total of 50 patients with Chronic Kidney Disease (CKD) underwent vascular access intervention during the above period. A temporary venous catheter (96%) in the right internal jugular vein was the most common mode of initiation of haemodialysis with 34.48% incidence of catheter related sepsis. Fifty percent of catheters were removed electively with mean duration of catheter survival of 77.23 ± 14.8 days. Wrist AVF (60%) was the most common site of AVF creation followed by arm (30%), mid-forearm (7.5%) and leg (2.5%). Complications include distal oedema (17.5%) and venous hypertension (2.5%). Primary failure occurred in 25% of patients and was more common in diabetic, elderly (>60 years) and in distal fistulas. Elderly patients (>60 years) starting dialysis with a CVC were more likely to be CVC dependent at 90 days. Late presentation and delayed diagnosis of chronic kidney disease (CKD) necessitates dialysis initiation through temporary catheter. Dialysis catheter with its attendant complications further adds to the morbidity, mortality, health care burden and costs. Early nephrology referral and permanent access creation in the pre dialysis stage could avert the unnecessary complications and costs of catheter.

Accuracy of the Central Landmark for Catheterization of the Right Internal Jugular Vein After Placement of the ProSeal™ Laryngeal Mask Airway

Improving Training in Nephrology Procedures: Yes We Can

Figure“Doctor, we need a central line on Ms. Smith, we've all tried, and she's got nothing.” After a quiet groan, we have several options to consider: search for a hidden peripheral vein, blind stick, external jugular, or go right to a central line. Central venous access begs further questions: femoral, internal jugular, subclavian. Surface landmarks or ultrasound-guided? Modern medicine has extended the lives of many patients with serious illness, which is obviously a good thing, but one of the consequences of modern medical care is the increasing difficulty of gaining IV access. In most EDs, venous access problems arise many times a day. We've all seen cases where diagnosis and treatment were delayed as a result of difficulties in venous access. The main fallback, the central line, is more invasive and has a significant complication rate. What is the proper sequence of peripheral and central veins to consider? How does bedside ultrasound affect our choices? Questions outnumber answers. It is important that all emergency departments understand and offer the complete spectrum of intravenous access methods to improve efficient patient care and reduce risk. Most intravenous catheters are easily started in the hand, forearm, or antecubital region, but what happens when your best clinician can't get into the veins in these areas after multiple attempts? The dorsal veins of the foot are used in the pediatric population without hesitation. What are the relative risks of using foot veins in the adult population? What are the risks of using the saphenous vein? The risks of using these secondary sites must be compared with the risks of inserting central lines. Remember, many of the complications such as deep vein thrombosis and line sepsis may occur after the patient has left the emergency department. How does edema of an extremity alter the decision? Are the risks of inserting an intravenous catheter in an arm mildly edematous from axillary lymph node dissection greater than the risks of a central line? Is the edema of fluid overload more or less prone to complications than from lymphatic obstruction? Is an IV in the foot of a fluid overloaded patient riskier than a femoral line? How are these risk-benefit ratios modified by diabetes, peripheral arterial disease, and the presence of risk factors for thromboembolic disease? Despite its importance in emergency medicine, a unifying theory of venous access seems to have fallen between the cracks. We will leave it to the academic community and professional societies to develop and promote sophisticated guidelines for this increasingly tough clinical challenge. A review of the literature reveals a growing chorus arguing that the use of bedside ultrasound dramatically improves access to peripheral as well as central veins. A small sample of Internet articles on the use of bedside ultrasound by physicians and nurses to locate peripheral veins are included here. (See box.) With minimal training and a bedside ultrasound device, these otherwise hidden veins can be cannulated in less time and with fewer sticks than with traditional methods. Online Sources Once you have decided a patient needs a central line, you'll decide which vein to use based on the immediate logistics, the clinical circumstances, and your level of comfort with the various approaches. Specific complications vary with specific sites. Femoral vein sites are prone to infection and thrombosis while the subclavian sites are subject to vascular injury and pneumothorax. The internal jugular site is prone to vascular injury. Standard emergency medicine texts describe placement of catheters in the major deep veins. (Roberts and Hedges' Clinical Procedures in Emergency Medicine is online at www.mdconsult.com.) Or you could turn to the New England Journal of Medicine online (http://content.nejm.org/cgi/content/full/348/12/1123/DC1) for a video on insertion of internal jugular and subclavian vein catheters (using the traditional landmark technique). As you might expect, the use of ultrasound to guide central line placement has been shown to improve outcomes and some consider it the standard of care. The web site of Washington University in St. Louis has a page entitled, “The Role of Ultrasound in Central Line Placement” that reviews several articles on ultrasound-guided central line placement. (http://emed.wustl.edu/emed/emed.nsf/J/7899E3EA153B9401862572050066A0A4?OpenDocument.) Cmedownload (www.cmedownload.com) has several videos illustrating the use of ultrasound for vascular access, which are available for purchase individually or as part of several multi-video series on ultrasound. Interventional radiologists have published useful articles that will expand your knowledge of central lines. Although they describe techniques and technology that are currently beyond the scope of most emergency departments, we recommend them to emergency physicians interested in an advanced understanding of central lines. The article “Quality Improvement Guidelines for Central Venous Access” from the Journal of Vascular and Interventional Radiology reviews definitions, indications, success rates, and complications of image-guided central venous access. (www.jvir.org/cgi/reprint/14/9/S231.pdf.) The more detailed article “Central Vein Access” from Emedicine at www.emedicine.com/radio/topic859.htm treats improved success rates using ultrasound for central line placement as an established fact. The article notes that ultrasound allows you to determine if the vein is thrombosed. The discussion on picc lines, ports, and dialysis catheters will increase your knowledge of these modalities. The section on guidewire complications will remind you not to pull hard on “stuck” guidewires of patients with pacemakers and IVC filters. There are several useful articles that motivate and describe the process of implementing ultrasound for IV access. With tight budgets and time constraints, these articles will assist you in negotiating with your hospital administration and your nursing staff. And don't forget, your hospital IV therapy team will benefit from a portable ultrasound unit. According to these and other authors, effective use of ultrasound improves the quality of care. Look for recommendations from the Agency for Healthcare Research and Quality (www.ahrq.gov/clinic/ptsafety/chap21.htm) for ultrasound guided placement of all central venous catheters. Given this, a Joint Commission mandate would not be surprising. ONLINE RESOURCES FOR PLACING VENOUS ACCESS LINESFigureAcademic Emergency Medicine: These articles suggest that a large majority of difficult-to-access patients will have an accessible peripheral vein when an ultrasound machine is used. “Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients,” www.aemj.org/cgi/content/abstract/11/12/1361. “Ultrasound-Guided IV Placement Superior to Traditional Approaches at Establishing Peripheral Intravenous Access in Difficult-access Patients,” www.aemj.org/cgi/content/abstract/11/5/582-b?ck=nck. “Success Rate of Peripheral IV Catheter Insertion by Emergency Physicians Using Ultrasound Guidance,” www.aemj.org/cgi/content/abstract/10/5/487-a. American Journal of Nursing: This article provides case histories and ultrasound images and describes the implementation process. The nurses achieved peripheral IV access in 87 percent of failed cases, the physicians 91 percent. They noted cannulation of the basilic and other deep veins required a 2.5 inch catheter to prevent dislodgement of the catheter. “EMERGENCY: Ultrasound-Guided Peripheral IV Insertion in the ED: A Two-Hour Training Session Improves Placement Success Rates in One ED,” www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=604776. Israeli Journal of Emergency Medicine: This review provides great detail of necessary elements for the implementation of ultrasound IV access program. “Ultrasound-Guided Peripheral Venous Access,” www.isrjem.org/Dec06_VenousAccess_Goldstein_postprod.pdf.

Background & Objectives:Catheterization of Internal Jugular Vein (IJV) is commonly attempted to obtain central venous access for hemodynamic monitoring, long term administration of fluids and inotropes, chemotherapeutic agents or corrosive drugs as well as total parenteral nutrition and hemodialysis in critical care patients. The catheterization of the IJV can be achieved by either anatomical landmark technique or the Ultrasound (USG) guided technique. The objective of our study is to find out if USG guided technique could be beneficial in placing central venous catheters by improving the success rate by reducing the number of attempts, decreasing the access time and decreasing the complications rate in comparison to the Landmark technique. Materials & Methods: Fifty patients scheduled for cardiac surgery requiring central venous cannulation of the right IJV were divided into two groups: USG guided group ‘U’ and the landmark guided group ‘L’, each consisting of 25 patients with age more than 15 years. The outcome measures were compared between the two groups in terms of success rate, time taken for successful cannulation and rate of complications. Results: The two groups were comparable in terms of age, weight, heart rate and blood pressure. The mean number of attempts for successful cannulation was 1.08±0.277 and 1.40±0.764 (p=0.055), the time taken in seconds for successful cannulation was 108.56±27.822 and 132.08±72.529 (p=0.137) and the overall complication rate was 0% (0 out of 25) and 32% (8 out of 25) (p=0.002) in the USG guided and the landmark technique group respectively. Conclusion: Our study has found that the use of USG in central venous cannulation of the internal jugular vein requires similar number of attempts and almost similar time for successful cannulation with that of the landmark technique. However the overall complications rate is markedly decreased by the use of USG than by the landmark technique for the central venous cannulation. Hence, we conclude that USG guided technique is much safer than the landmark technique to reduce the inadvertent complications during central venous cannulation. However, USG guided center venous catheterization of internal jugular vein has no difference in comparision to the landmark technique in terms of number of attempts and the time required for successful cannulation. Disclosure of Interest: None declared

To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock. The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites. Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05). In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.

Aim: Ultrasound (USG)-guided hemodialysis catheter placement is known to be superior to and more reliable than catheter insertion guided by anatomical landmarks. USG is used for vascular mapping (VM) before catheter placement, or real time. This study investigated the effect on outcomes of USG techniques used in patients with hemodialysis catheters inserted through the internal jugular vein (IJV) due to emergency hemodialysis indication while being monitored for Predialysis Renal Failure (PRF). Material and Methods: Fifty-nine patients with PRF undergoing USG-guided hemodialysis catheter placement between January 2012 and May 2014 at the Balikesir University Health Practice and Research Hospital were evaluated retrospectively. Results: Twenty-eight patients were male and 31 female. The right IJV was used in 57 patients and the left IJV in two. Success rate at first attempt in real time USG group was 91.3% (21/23), compared to 91.6% (34/36) in the VM group. Average number of puncture was similar (1.08±0.291 vs. 1.16±0.56). No complications occurred in either group. Conclusion: Use of USG in real time and for VM in patients with PRF gives similar results in terms of success and complication rates. We therefore recommend that USG only for vascular mapping be used solely in these patients in order to avoid time loss and increased costs.

Horner Syndrome Caused by Internal Jugular Vein Catheterization