Internal Jugular Vein Catheterization Research Articles

Combined short- and long-axis method for internal jugular vein catheterization in premature newborns: A randomized controlled trial.

Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique. A total of 90 premature newborns (gestational age <37weeks and <28days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n=45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups. The two groups (n=45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs 46.7%, χ2 =5.5533, P=.0184) and significantly fewer needle passes (1.0[1.0-2.0] vs 2.0[1.0-3.0], χ2 =-2.6094, P=.0091). There was no significant difference between the groups in the procedure time (368[304-573] vs 478[324-79]s, Z=-1.7690, P=.0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ2 =4.4056, P=.0358). Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.

Comparison of external jugular vein-based surface landmark approach and ultrasound-guided approach for internal jugular venous cannulation: A randomised crossover clinical trial.

Historically, landmark techniques for central venous access through the internal jugular vein (IJV) have yielded a lesser success rate and higher complication rate than the ultrasound (US)-guided approach. The purpose of this study is to assess the success and safety of a novel external jugular vein (EJV)-based landmark (EJV-LM) approach compared with the real-time US-guided approach for central venous access through the IJV. This was a prospective, randomised, crossover trial performed in patients during elective cardiac and non-cardiac surgery. Each resident randomly inserted a central venous catheter using EJV-LM approach and real-time US-guided approach. The primary outcome was first-attempt success. Secondary outcomes included overall success rate, number of puncture attempts, cannulation time, haematoma and mechanical complications. A total of 188 patients were randomly assigned to the EJV-LM and US groups. The demographic characteristics of the groups were comparable. The first-attempt success was not different between EJV-LM and US-guided techniques (79.8%; [95% CI: 70.2-87.4] vs 89.4% [95% CI 81.3-94.8]; P=.06). The overall success rate was 100% with both techniques. There were no differences in the number of puncture attempts with introducer needle (1[1-3] vs 1[1-2]; P=.07). Cannulation time was longer in the EJV-LM group compared with the US group (58.11±6.6 vs 44.27±5.28seconds; P=.0001). EJV-LM technique was associated with a higher occurrence of overall complications compared with the US technique (12.8% [95% CI: 6.7- 21.2] vs 4.2% [95% CI: 1.1-10.5]; P=.03). No major mechanical complications were observed with either techniques. In patients with non-distorted neck anatomy and a visible EJV, IJV catheterisation using the EJV-based LM approach and standard US-guided technique yielded similar first-attempt and overall success rates. Cannulation time was longer and complications occurred more frequently in the EJV-based LM compared with the standard US-guided technique.

Central Venous Catheter Insertion: A Scoring System for Evaluation of Both the Procedure and the Operator (CVCI Score/Gaber Score).

Introduction Currently, there is no method to assess the performance while inserting a central venous catheter. We suggest a new scoring system for evaluation of both the technique as well as the operator, and then we applied it for the comparison between the landmark and ultrasound techniques to assess its validity. Methods. Four hundred patients were divided into two equal groups: group (A): internal jugular vein (IJV) and group (B): subclavian vein (SV). The landmark technique and the ultrasound guidance were used equally (100 patients for each) in both groups. Results In group (A), 20% of patients in the landmark group achieved score 4, while 82% of patients in the ultrasound group achieved the same score. This suggests that the ultrasound technique for catheterization of IJV decreased overall complications and improved the success rate. In group (B), there were 70% of patients in the landmark group who achieved score 5, while 49% of patients in the ultrasound group achieved the same score which proposes that the landmark technique might be deceptively better than the ultrasound technique for catheterization of SV. This could be because the time required for catheterization of SV by the ultrasound technique was longer than that in the landmark technique. Overall complications of 15% with the landmark technique vs. 2% with ultrasound guidance in this group of patients are not only statistically significant but also increase morbidity and mortality with a highly invasive procedure. Complications and their incidences are by far more significant than seconds of time. Our results suggest that the ultrasound technique could decrease the incidence of overall complications, but it is time-consuming in group (B). These results support the validity of our new scoring system. Conclusion We suggest a new scoring system for CVC insertion that can be used for evaluation of both the technique and the operator. It can evaluate the performance of junior staff and follow their progress. It can be applied in the medical and critical care practice as well as the quality management privileges and protocols.

Routine chest X-ray following ultrasound-guided internal jugular vein catheterization in critically ill children: A prospective observational Study.

Recent studies in adults have shown that routine chest X-ray following ultrasound-guided central venous catheter insertion through the internal jugular vein is unnecessary due to a low rate of complications. To assess the usefulness of routine chest X-ray following ultrasound-guided central venous catheter insertion through the internal jugular veins in critically ill children. A prospective observational study was conducted at a pediatric intensive care unit of a tertiary, university-affiliated pediatric medical center. All children under the age of 18 who underwent ultrasound-guided central venous catheter insertion through the right or left internal jugular vein between May 2018 and November 2019 were evaluated for eligibility. Procedures were prospectively documented, and chest X-ray was screened for pneumothorax, hemothorax, central venous catheter tip position, and resultant corrective interventions. Of 105 central venous catheter insertion attempts, 99 central venous catheters (94.3%) were inserted. All were located within the venous system. None were diagnosed with pneumo/hemothorax on chest X-ray. Twenty (20.2%; 95% CI 12.8%-29.5%) were defined as malpositioned by strict criteria; however, only one (1%) was judged significantly misplaced by the clinical team leading to its repositioning. In this critically ill pediatric cohort, all central venous catheters inserted under ultrasound guidance could have been used with safety prior to acquiring chest X-ray. Overall chest X-ray impacted patient management in only 1% of cases. Our results do not support delaying urgent central venous catheter use pending chest X-ray completion in critically ill children.

EXTRA-CORPOREAL CARBON DIOXIDE REMOVAL IN COVID-19 ARDS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Management of Acute Respiratory Distress Syndrome (ARDS) involves lung-protective mechanical ventilation with an emphasis on low pressure and low tidal volume ventilation(LTVV). Permissive hypercapnia is a known consequence of LTVV, the progression of which can lead to hemodynamic instability and death. Management of hypercapnia in such cases may require ventilator settings which may exceed known lung protective strategies. The incidence of ARDS in SARS-coV-2 is approximately 30% which has increased emphasis on ventilator management. Extracorporeal carbon dioxide removal (ECCO2R) utilizes a gas exchange membrane to remove carbon dioxide from the blood and control hypercapnia while still allowing lung-protective mechanical ventilation. We report the first case of ECCO2R safely and successfully utilized to manage life-threatening hypercapnia in severe ARDS related to COVID-19. CASE PRESENTATION: A 57-year-old male with a history of hypertension presented to our hospital with severe ARDS secondary to COVID19. He was intubated at an outside institution 7 days prior and transferred for management of refractory hypercapnia. ABG revealed pH:6.9, CO2:188 mmHg,O2:93 on 100% FiO2. ECCO2R was emergently initiated using a 15.5 Fr catheter in the right internal jugular vein. The sweep was initially set at 3L/min, the blood flow at 500ml/min. Repeat ABG improved to a pH of 7.17 and CO2 of 80mmHg. Ventilator requirements were weaned to achieve acceptable pressures (Pressure control: pressure support:5, PEEP:18). His pH and pCO2 gradually normalized. On day 5, ABG showed a pH:7.27, CO2:55 sweep was turned to 0 and he was able to maintain a pCO2 of 52 for 24 hours, after which a decision was made to decannulate. His hospital course was prolonged due to hypoxemic respiratory failure, transient renal failure requiring dialysis, and difficulty with sedation. A tracheostomy was performed on day 31. The patient was successfully weaned off the ventilator on day 37 and discharged home after 41 days in the ICU. DISCUSSION: ECCO2R has been utilized in ARDS to facilitate “ultra-low” volume mechanical ventilation in cases with refractory respiratory acidosis and facilitate weaning from assisted mechanical ventilation. This case demonstrates the successful utilization of ECCO2R in a patient with COVID19. Despite significantly elevated d-dimer levels the patient did not experience complications related to circuit thrombosis or bleeding and was maintained on full-dose anticoagulation throughout his hospital stay. CONCLUSIONS: This case highlights the use of ECCO2R in severe ARDS and refractory hypercapnia related to COVID19. ECCO2R may be more advantageous and an acceptable alternative in comparison to other rescue modalities in this population. Future studies are required to further investigate its safety and efficacy. Reference #1: 19 Registry. COVID. https://sccmcovid19.org/. Published May 30, 2020. Accessed May 30, 2020 Reference #2: Staudinger T. Update on extracorporeal carbon dioxide removal: a comprehensive review on principles, indications, efficiency, and complications [published online ahead of print, 2020 Mar 10]. Perfusion. 2020;267659120906048. doi:10.1177/0267659120906048 Reference #3: Jacobs JP, Stammers AH, St Louis J, et al. Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19: Experience with 32 patients [published online ahead of print, 2020 Apr 17]. ASAIO J. 2020;10.1097/MAT.0000000000001185. doi:10.1097/MAT.0000000000001185 DISCLOSURES: No relevant relationships by Sukhmani Boparai, source=Web Response Scientific Medical Advisor relationship with ALung Technologies, Inc. Please note: $5001 - $20000 Added 06/01/2020 by Steven Conrad, source=Web Response, value=Consulting fee No relevant relationships by Nasim Motayar, source=Web Response No relevant relationships by L. Keith Scott, source=Web Response

Applying endoluminal catheter colonization surveillance cultures in renal dialysis unit - an effort to reduce CRBSI rate

Introduction: Catheter related blood stream infection (CRBSI) is a common complication with the use of central venous catheters (CVC) in hemodialysis patients. The study was designed to evaluate the effect of implementation of surveillance cultures (SCs) on the rate of CRBSIs.Methodology: this prospective cohort study was done over a period of 6 months on hemodialysis patients with internal jugular vein catheters. CRBSIs rates were measured and compared in the 2 included groups, the study group (15 patients) and the control group (15 patients). In both groups, conventional infection prevention and control measures were applied. Patients in the study group were checked for intraluminal microbial colonization every 2 weeks by SCs. According to SCs results, patients were classified into 4 groups, then according to the group they were managed with antibiotic lock therapy (ALT) with or without systemic antibiotics. Results: of the collected 140 SCs from the study group, 108 (77%) were negative and 32 (23%) were positive. Eighteen cases in groups 2 & 3 received ALT and 6 patients in group 4 received ALT and systemic antibiotic. SCs succeed to eliminate intraluminal microbial colonization in all positive cases except for 1 case in group 2 and 3 cases in group 4. The CRBSI rate was 2.14 per 1,000 catheter days in the study group compared to 5.57 per 1,000 catheter days in the control group (P=0 .037).Conclusion:This study shows that the implementation of periodic SCs is associated with a significant reduction in the CRBSI rates in hemodialysis patients.

Unknown Partial Anomalous Pulmonary Venous Connection Causing Arterial Blood Gases During Central Venous Catheter Insertion

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly. We report about the case with an “arterial blood gas” analysis taken from a newly inserted central venous catheter (CVC). Thoracic computed tomography (CT) verified the catheter in the left internal jugular vein. The contrast was given through the catheter which revealed a partial anomalous venous connection of the left upper pulmonary vein to the left brachiocephalic vein. PAPVC should be taken into consideration in cases of “arterial blood gases” taken from a correctly inserted CVC. Most patients are asymptomatic. Adequate diagnostic tools to detect PAPVC are TEE, CT or MRI.

Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters.

BackgroundCentral venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmia's, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications.ObjectiveTo compare Peres’ formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach.Materials and methodsA total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups—Peres’ group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups.ResultsAbout 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups.ConclusionRadiological landmark formula is superior to Peres’ formula for measuring optimal depth of insertion of right internal jugular venous catheter.How to cite this articleManudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24(7):527–530.

Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery

Background and aimIn patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO2 indirectly. In this study, we aimed to determine the correlation between ScvO2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery.Materials and methodsFifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO2, were recorded at certain times until postoperative 24th hour.ResultsData were collected at 8 different time points. There was a significant correlation between ScvO2 and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between ScvO2 and NIRSijv was 2.92% and the limits of agreement were from 11% to –5.2%. There was a moderate correlation between ScvO2 and NIRSc (r = 0.45), (P = 0.001). The mean bias between ScvO2 and NIRSc was 2.7% and the limits of agreement were from +26% to –20%.ConclusionIn this study, we found a strong correlation between ScvO2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.

Application of thromboelastography combined with point-of-care ultrasound to prevent internal jugular vein catheterization related thrombosis

To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis. The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded. Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.

Incidental subclavian artery injury during right internal jugular vein catheterization via ultrasonography

Incidental subclavian artery injury during right internal jugular vein catheterization via ultrasonography

P1314TEN YEAR EXPERIENCE ON VASCULAR ASSESS PLACEMENT BY NEPHROLOGIST

Abstract Background and Aims Across the globe, vascular assess placement for haemodialysis is performed by Anaesthesiologist, Nephrologist, Radiologist, and surgeons depending on the experts availability of that locality. Patient care should not suffer because of lack of round the clock surgical and radiological expertise. We would like to share our ten year experience of vascular assess placement and their outcomes which were performed in the Department of Nephrology. Method A total 11429 vascular assess procedures have been carried out during 2009 to 2019. There were 781 AVF, cuffed 476 and non-cuffed 10172 (Internal Juglar 5375, Subclavian 2042 and femoral 2755) catheter insertions were performed. For construction of AVF, Pre-procedure ultrasound Doppler was performed to see both the anatomy of vein and artery. Radiocephalic and brachiocephalic AVF construction were done by side to side arteriovenous anastomosis using 6-0 Prolene double ended needle under strict asepsis. Insertion complications (bleeding and air-embolism), procedure time, patency, blood flow, and post-procedure complications (hematoma) were recorded. Follow up was done on 10th and 30th day of post surgical period. Of 476 Permcath, 58 were placed without valve guided peel away sheath catheters and rest with valve guided peel away sheath catheters in right internal jugular vein. Results Of 781 AVF, 557 (71.3%) were males and mean age 42.7±15.1 years. Of them, diabetes 330 (42.25%) and non-diabetes 451 (57.74%) were, Basic disease were DM 134 (16.15%), HTN 115 (14.72%), CGN 121 (15.49%), CTIN 124 (15.87%), Unknown 173 (22.15%) and others 114 (14.59%) were respectively. Common sites of AVF site were were left radiocephalic 319 (40.84%), left brachiocephalic 321 (41.1%) and both side brachiobasilic 141 (18%). Pre procedure ultrasound doppler findings were arterial diameter 2.79±0.96, venous diameter 2.75±0.86, arterial pulse wave velocity 57.93±19.49, diameter. The average duration of the procedure was 70 min without any intra operative complication. Five patients developed post-operative bleeding required re-exploration. The average duration between the construction of the fistula and the day of successful cannulation was 37 days. After six weeks venous diameter were 5.06±1.58 having blood blow of 766.17±536.36 ml/min. Successful cannulation could be done in 418 (53.52%) patients and another 363 (46.47%) patients did not have satisfactory thrill even after the stipulated time of maturation were declared failed AV fistulas. Other common complications observed were stenosis 351 (44.94%), edema 140 (17.92%), ischemia 124 (15.87%), thrombosis 124 (15.87%), infections 109 (13.95%) and aneursyms 112 (14.34%) respectively The technical success rate of catheter placement were 98% without any major insertion or post-procedure complications. Average procedural time was 20 minutes. Mal position of Permcath was seen in 38 (7.9%) patients, catheter thrombosis 45 (9.4 %) patients. Conclusion It is quite safe for nephrologists to perform surgical procedures required for vascular access for dialysis. The valve-guided tunnelled catheter insertion and side to side anastomosis AVF construction may be adopted as a routine practice by the Nephrologists.

Bailout subclavian artery stenting in a sick child with iatrogenic subclavian artery perforation: a case report

BackgroundSubclavian artery injury during internal jugular vein catheterization is a rare yet potentially life-threatening complication leading to hemothorax and exsanguination. The percutaneous endovascular approach offers a less invasive and effective alternative to the high-risk surgical repair in emergent situations.Case presentationWe present a case of a 6-year-old child suffering from hemolytic uremic syndrome requiring urgent hemodialysis, for which IJV (internal jugular vein) cannulation was attempted. This procedure led to iatrogenic subclavian arterial perforation causing massive hemothorax with hemodynamic compromise. CT angiogram showed a through and through perforation in the first part of right subclavian artery between common carotid and vertebral artery. A definitive assessment of the extent of ongoing leak was made through an invasive angiogram in the catheterization laboratory. The perforation was successfully closed percutaneously with a covered stent without compromising any branch vessels.ConclusionArterial injury although rare is a potentially life-threatening complication of IJV cannulation which warrants immediate attention and corrective measures. Ultrasound guidance can reduce the risk of such life-threatening complications. Percutaneous management offers a less invasive, less time consuming, and effective alternative in critically ill patients in emergency situations.

SUN-284 MINITHEATER: A VIABLE OPTION FOR INTERVENTIONAL NEPHROLOGY PRACTICE IN RESOURCE POOR SETTINGS

Interventional Nephrology (IN) is a new and emerging subspecialty of Nephrology that mainly deals with: renal ultrasonography and ultrasound-guided renal biopsy, dialysis access creation and dialysis access related percutaneous endovascular procedures. The dependence on other specialists to perform these procedures often resulted in delays in renal patient treatment, hence the birth of IN. Unfortunately, cost prohibits the establishment of an ideal IN centre in resource poor settings. To establish a viable IN practice in resource poor settings using minitheater. A minitheater space, trained nephrologist, couch, light source, trolley, surgical instruments, biopsy set, ultrasound machine and skin cleaning agents. UNTH Interventional nephrology minitheater At the Renal Unit of University of Nigeria Teaching Hospital Enugu, Nigeria, we set up a minitheater and organized an International Society of Nephrology (ISN) Continuing Medical Education (CME) training programme for nephrologists and nephrology trainees in May 2019. Seventy- seven participants from 17 centers in 4 out of the 6 geopolitical zones in Nigeria were in attendance. During the pilot study, 2 arteriovenous fistulae, 6 tunneled right internal jugular vein catheter placements, 5 adult and 4 pediatric real- time ultrasound- guided kidney biopsies were performed in the minitheater by the nephrologists. There was no procedural complication. Following this training programme, 3 centers have set up and are utilizing minitheaters for IN. It is feasible to set up and run a viable IN programme in resource poor settings using a mnitheater. This removes reliance on surgeons and radiologists making the nephrologist independent and ensuring prompt care of renal patients.

Application of wireless ultrasound-guided internal jugular vein catheterization in hemodialysis patients

Objective To explore the effectiveness and safety of wireless ultrasound guidance in the treatment of internal jugular vein catheterization in hemodialysis patients. Methods We collected 120 patients who were treated in our hospital's blood purification center from October 2017 to October 2018, then we made a random grouping, divided into traditional group and wireless ultrasound group, each group was 60 cases.Anatomical markers were used to locate and puncture in the traditional group, while the location and puncture of the wireless ultrasound group were performed under the guidance of wireless ultrasound. The gender, age, body mass index(BMI), number of difficult catheterizations, average puncture time, average puncture frequency, one puncture success rate, secondary puncture success rate, total puncture success rate, and complication rate were compared between the two groups. Results There were no significant differences in clinical data between gender, age, BMI and number of difficult catheterizations between the two groups(P>0.05). The average puncture time, average puncture frequency and complication rate in the wireless ultrasound group were lower than those in the traditional group, and the difference was statistically significant(P<0.05). The success rate of one puncture and the success rate of secondary puncture in the wireless ultrasound group were higher than those in the traditional group, and the difference was statistically significant(P<0.05). Conclusions Wireless ultrasound-guided internal jugular vein catheters are more convenient, easier, safer, and faster.It is safer and more effective for patients with difficult catheterization(obesity, history of internal jugular vein catheterization, incompatibility of body position, vascular malformation, edema). Key words: Renal Dialysis; Punctures; Ultrasonography, Doppler, Color

Goal-directed fluid therapy using transoesophageal echocardiographic inferior venacaval index in patients with low left ventricular ejection fraction undergoing major cytoreductive surgery: A clinical trial.

Background and Aims:This study aims to trans oesophageal echo cardiographically (TOE) measure inferior venacava diameter (IVCD) during inspiration and expiration in poor left ventricular ejection fraction (LVEF) patients undergoing cytoreductive oncosurgery, to ascertain if any correlation exists between, caval index (DeltaIVCD), and stroke volume variation (SVV), and to compare DeltaIVCD-guided versus SVV-guided fluid therapy.Methods:In this prospective, parallel group, interventional study, seventy American Society of Anesthesiologists-III patients, aged 30-75 years, weighing 40-90 kg, with LVEF ≤40% undergoing cytoreductive surgery were included and randomised to group-D (DeltaIVCD-guided fluid therapy) and group-S (SVV-guided fluid therapy). Patients with oesophageal lesions were excluded. After standard endotracheal anaesthesia, arterial and internal jugular vein catheters were placed. A TOE probe was inserted in the interventional group-D. Quantification of IVCD respiratory variations was done. Heart rate (HR), arterial oxygen saturation (SPO2), mean arterial pressure, end tidal carbondioxide (EtCO2), central venous pressure, SVV, IVCD, and urine output (UO) were recorded every 30 min. Post-operative arterial blood gas analysis, lung-ultrasound, chest-radiograph, and serum creatinine were done.Statistical Analysis:Pearson's correlation coefficient as measure of strength of linear relationship, calculation of regression equation, and unpaired t-test for normally distributed continuous variables were used.Results:A positive correlation between DeltaIVCD and SVV (r = 0.751) was observed. A regression equation was obtained for SVV (SVV = [0.317 × DeltaIVCD] + 5.877). Serum lactate, estimated glomerular filtration rate, HR, and UO were within normal limits in group-D. There was no pulmonary oedema.Conclusion:DeltaIVCD-guided intravenous fluid therapy is valuable in low LVEF patients where tight fluid control is essential and any fluid overload may precipitate cardiac failure.

Hemodialysis catheter - related thrombosis of the internal jugular vein in an elderly diabetic woman: a case report and review of literature

Internal jugular vein (IJV) catheters are commonly used as vascular access for hemodialysis (HD) patients. They may have certain drawbacks, including infections and thrombotic complications, some of which could be life-threatening. We presented a 75 year old diabetic woman on maintenance dialysis who developed right sided neck and facial swelling. She had been receiving HD via a tunneled jugular venous catheter inserted on the same side 4 months prior. A Doppler ultrasound and CT angiography revealed a thrombus in the right IJV. She was managed conservatively with anticoagulants including heparin, warfarin and apixapan with resolution of symptoms. If diagnosed promptly, catheter related thrombosis can be managed with good outcome. However, to reduce the incidence of thrombotic complications in chronic HD patients, arteriovenous fistula (AVF) should be preferably used.

A prospective randomized study to compare short axis and long axis techniques of ultrasound guided internal jugular vein catheterizations

A prospective randomized study to compare short axis and long axis techniques of ultrasound guided internal jugular vein catheterizations

Practical guide for safe central venous catheterization and management 2017.

Central venous catheterization is a basic skill applicable in various medical fields. However, because it may occasionally cause lethal complications, we developed this practical guide that will help a novice operator successfully perform central venous catheterization using ultrasound guidance. The focus of this practical guide is patient safety. It details the fundamental knowledge and techniques that are indispensable for performing ultrasound-guided internal jugular vein catheterization (other choices of indwelling catheters, subclavian, axillary, and femoral venous catheter, or peripherally inserted central venous catheter are also described in alternatives).

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study.

The most common complication following internal jugular vein catheterization is the puncture of the common carotidartery. We aimed to find an optimal head rotation angle for safe vein catheter insertion while minimizing the risk of arterypuncture. Eighty-two patients admitted to the intensive care unit were included in the prospective study. Ultrasound examination of the neck vessels on the right side was performed in the neutral position and at a head rotation of 15°, 30°, 45° and 60° to the left. Internal jugular vein and common carotid artery puncture angle, overlapping angle of vein by artery and vein safe puncture angle were evaluated. The internal jugular vein puncture angle increased with head rotation from the neutral position to 30° and 45° and was largest at 60° (p<0.001 for all). The overlapping angle increased significantly at 45° and 60° rotation compared with the neutral position (p<0.001 for all). The vein safe puncture angle was highest at 30° and significantly different from the neutral position and 60° (p=0.003 and p=0.013, respectively). When performing right internal jugular vein catheterization without ultrasound guidance by using an out-of-plane technique, the head should be rotated at 30°, because the overlapping angle increases with further head rotation and can increase the risk of artery puncture.