Internal Jugular Vein Catheterization Research Articles

Inadvertent carotid-jugular conduit: An uncommon yet dreaded jugular venous catheterization complication

Carotid-jugular fistula is one of the uncommon complications of internal jugular vein catheterization. It can have serious consequences such as infection, embolization, and high output cardiac failure and requires invasive repair. We describe a case of a common carotid artery-jugular vein arteriovenous fistula following the insertion of a double-lumen catheter for hemodialysis access.

A comparative study of advantages and disadvantages of anterior and posterior approach for internal jugular vein catheterization

A comparative study of advantages and disadvantages of anterior and posterior approach for internal jugular vein catheterization

Lateral oblique approach for internal jugular vein catheterization: Randomized comparison of oblique and short-axis view of ultrasound-guided technique.

OBJECTIVE:The lateral oblique approach is a novel needle-in-plane technique for ultrasound-guided catheterization of the internal jugular vein. In this study, we aimed to compare the oblique approach with the classical short-axis technique for facilitating the procedure and reduction of mechanical complications.METHODS:This research was planned as a prospective study. Eighty-four open-heart surgery patients requiring a central venous catheter were randomly allocated into two groups: Oblique approach group (n=42) and short-axis group (n=42). Time to cannulate, the number of necessary puncture attempts, and frequency of carotid artery puncture, hematoma, puncture site bleeding, pneumothorax, and hemothorax in each group were recorded. Visualization of the vein and the needle using ultrasound were also evaluated by a subjective scale.RESULTS:The patient’s characteristics were comparable between the two groups. The mean time of catheterization was 52.00±70.18 seconds in the oblique approach group and 40.76±49.30 seconds in short-axis group. The mean number of needle puncture attempts was 1.21±0.61 in oblique approach and 1.12±0.50 in short-axis group. The results did not differ significantly. There was an improved visualization of the needle in the oblique approach group, but this was not proved as statistically significant.CONCLUSION:The results of our study suggest that the lateral oblique approach is a safe and effective technique, which can be a strong alternative to the classical short-axis technique for ultrasound-guided catheterization of the internal jugular vein.

Current Concepts in Hemodialysis Vascular Access Infections.

Infection-related causes are second only to cardiovascular events for mortality among end-stage renal disease patients. This review will provide an overview of hemodialysis catheter-, graft-, and fistula-related infections with emphasis on diagnosis and management in specific settings. Use of catheters at the initiation of dialysis has remained unchanged at 80%. Of all access-related bloodstream infections (BSIs), 70% occur in patients with catheters. The risk factors for BSIs in tunneled, cuffed catheters include the duration of the catheter, past catheter-related bacteremia, left-sided internal jugular vein catheters, hypoalbuminemia, and immunosuppression. Surprisingly, human immunodeficiency virus infection has not been associated with a higher risk of catheter-related bacteremia. Catheter-related bloodstream infection is a clinical definition that requires specific laboratory testing to identify the catheter as the source of the BSI. A central line-associated bloodstream infection is a primary BSI in a patient who had a catheter within the 48-h period before the development of the BSI with no other identifiable source. Guidewire exchange of catheter is a viable alternative in select patients to aid in preserving venous access sites. Catheter lock therapy can decrease infectious complications and mortality. Arteriovenous graft infections are prevalent with significant morbidity. Studies evaluating the impact of stent use in infection risks of the arteriovenous graft are sorely needed.

An Accidental Arterial Puncture and Anticoagulation after Internal Jugular Vein Catheterization Resulting in Massive Hematoma and Airway Compromise

An Accidental Arterial Puncture and Anticoagulation after Internal Jugular Vein Catheterization Resulting in Massive Hematoma and Airway Compromise

Analysis of the reasons and influencing factors of unplanned removal of implantable venous access port in tumor patients

Objective To explore the reasons and influencing factors of unplanned removal of implantable venous access port (IVAP) in tumor patients, and analyze its influencing factors, so as to explore the corresponding clinical interventions. Methods A total of 1 029 cases of tumor patients who were implanted IVAP in Zhejiang Cancer Hospital from January 1st, 2009 to December 31st, 2016 were recruited by convenience sampling method. Univariate analysis and Logistic regression analysis were applied to analyze the influencing factors of unplanned port-taking. Results Finally 1 002 tumor patients were recruited excluding patients who died or lost follow-up. Excluding patient's subjective factors, catheter-related blood stream infection (CRBSI) , catheter clamping syndrome, and pain around infusion seat were the main causes of unplanned removal of IVAP. Univariate analysis revealed that there were significant differences in unplanned port removal among patients with different catheterization veins, infection and coagulation function (χ2=15.691, 14.425, 16.732; P<0.001) . Logistic regression analysis showed that internal jugular vein catheterization (OR=8.272) , infection (OR=2.592) and coagulation (OR=2.709) were the main factors. Conclusions Medical staff should strictly control the causes and influencing factors of unplanned removal of IVAP when implanting and maintaining the use of IVAP for patients, so as to prolong the use time of infusion port. Key words: Neoplasms; Implantable venous access port; Influencing factors; Unplanned port removal

1394. A Translational Pharmacokinetic Rat Model of Cerebral Spinal Fluid (CSF) and Plasma Concentrations of Cefepime

BackgroundFor treatment of central nervous system infections caused by GNB, adequate cefepime concentrations are required in the cerebral spinal fluid (CSF) and brain. However, high plasma cefepime exposures have resulted in neurotoxicity. There is a need to understand the real-time pharmacokinetic (PK) relationship between plasma and CSF concentrations as serial CSF sampling is not regularly performed.MethodsMale Sprague-Dawley rats received cefepime via an internal jugular vein catheter. A total daily dose of 150 mg/kg/day was administered as a single injection every 24 hours for 4 days. Plasma samples (mean n = 5 per rat) was obtained via a second dedicated catheter, with up to five samples obtained on a single concentration–time curve. CSF sampling occurred via an intracisternal catheter, with up to two samples taken every 24 hours. Cefepime in plasma and CSF were quantified via LC–MS/MS. PK analyses were conducted using Pmetrics for R. Multiple physiologic compartmental models were fit, with the ultimate model selected by Akaike score and rule of parsimony. Each rat’s concentrations were predicted from the final model, and predictive performance was evaluated with bias and imprecision of the population and Bayesian posterior prediction models. PK parameters were estimated, and PK exposures during the first 24 hours (i.e., AUC0–24, CMAX0–24, CMIN0–24) were calculated for each rat from Bayesian posteriors.ResultsEleven rats contributed PK data. A three-compartment model fit the data well [Figure 1: Plasma, Population (a) and Bayesian (b); Figure 2: CSF, Population (a) and Bayesian (b)]. Population median parameter values (CV%) for rate constant (Ke), volume central compartment (V1), volume CSF compartment (V3), rate to/from central/peripheral compartment (KCP, KPC), rate to/from central/CSF compartment (K13, K31) were: 5.04 hour−1 (43.4%), 0.069 L (39.24%), 0.28 hour−1 (52.11%), 17.42 hour−1(34.83%), 0.32 hour−1 (165.3), 0.31 hour−1 (79.89), respectively. Noncompartmental analysis of the Bayesian posteriors revealed a plasma median half-life, AUC0–24, CMAX0–24, and CMIN0–24 of 2.6 hours, 158.1 mg hour/L, 189.3 mg/L, and 0.0003 mg/L from the first dose.ConclusionCefepime transit to the CSF is rapid and highly predictable in the rat model. This model will be highly useful for understanding neurotoxicity outcomes for cefepime. Disclosures J. Liu, Merck: Grant fund from Merck, Research grant.

1419. 24-Hour Pharmacokinetic Relationships for Intravenous Vancomycin and Novel Urinary Biomarkers of Acute Kidney Injury

BackgroundVancomycin induces exposure-related acute kidney injury; yet only troughs are generally monitored in patients. In rat models, intraperitoneal dosing results in highly variable drug exposures. Thus, intravenous (IV) vancomycin was used to assess pharmacokinetic-toxicodynamic (PK-TD) relationships with nephrotoxicity.MethodsMale Sprague-Dawley rats received IV vancomycin via an internal jugular vein catheter. Total daily doses ranging from 150 to 400 mg/kg/day were administered as a single or twice daily injection over 24 hours. Controls received IV saline. Plasma sampling was conducted via a second dedicated catheter, with up to eight samples in 24 hours. Twenty-four-hour urine was collected during this time and assayed for kidney injury molecule 1 (KIM-1), osteopontin (OPN) and clusterin using the MILLIPLEX MAP Rat Kidney Panel. Vancomycin in plasma was quantified via LC–MS/MS. PK analyses were conducted using Pmetrics for R. PK exposures during the first 24 hours (i.e., AUC0–24, CMAX0–24, CMIN0–24) were calculated from Bayesian posteriors. PK-TD relationships were assessed with Spearman’s rank coefficient (rs) and the best fit mathematic model (e.g., exposure response curve fitting in GraphPad v.7).ResultsForty-five vancomycin treated and five control rats contributed PK-TD data. A two-compartment model fit the data well (Figure 1: Population [a], Individual [b]). An exposure-response relationship was found between AUC0–24 vs. KIM-1 (Figure 2a) and osteopontin (Figure 3a) and CMAX24 vs. KIM-1 (Figure 2b) and osteopontin (Figure 3b) by four-parameter Hill fit. A weaker relationship was found for CMIN0–24 hours vs. KIM-1 (R2 = 0.46) and less parity existed between PK measures and osteopontin, though AUC24 was best (R2 = 0.66), all by four-parameter Hill fits. Spearman’s rs showed significant correlations between AUC0–24 vs. KIM-1, AUC0–24 vs. osteopontin and CMAX0–24 vs. osteopontin (P < 0.001, rs = 0.53, rs = 0.75, rs = 0.65).ConclusionVancomycin induced kidney injury is most driven by AUC or CMAX. Clinical monitoring should focus on CMAX and AUC and move away from trough only sampling. Disclosures J. Liu, Merck: Grant fund from Merck, Research grant. W. Prozialeck, Midwetsren University: Collaborator, Grant recipient.

The effect on early renal function of various dynamic preservation strategies in a preclinical pig ischemia-reperfusion autotransplant model.

The aims of this study were to determine the most optimal timing to start machine perfusion during kidney preservation to improve early graft function and to evaluate the impact of temperature and oxygen supply during machine perfusion in a porcine ischemia-reperfusion autotransplant model. The left kidney of an approximately 40-kg female Belgian Landrace pig was exposed to 30 minutes of warm ischemia via vascular clamping and randomized to 1 of 6 study groups: (1) 22-hour static cold storage (SCS) (n = 6), (2) 22-hour hypothermic machine perfusion (HMP) (n = 6), (3) 22-hour oxygenated HMP (n = 7), (4) 20-hour HMP plus 2-hour normothermic perfusion (NP) (n = 6), (5) 20-hour SCS plus 2-hour oxygenated HMP (n = 7), and (6) 20-hour SCS plus 2-hour NP (n = 6). Graft recovery measured by serum creatinine level was significantly faster for continuous HMP preservation strategies compared with SCS alone and for all end-ischemic strategies. The active oxygenated 22-hour HMP group demonstrated a significantly faster recovery from early graft function compared with the 22-hour nonactive oxygenated HMP group. Active oxygenation was also found to be an important modulator of a faster increase in renal flow during HMP preservation. Continuous oxygenated HMP applied from the time of kidney procurement until transplant might be the best preservation strategy to improve early graft function.

A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study

The short-axis out-of-plane approach (SAX-OOP) is commonly used in ultrasound-guided internal jugular vein catheterization. However, this approach has a risk of posterior vein wall injuries. The authors hypothesized that a shallow angle of approach may reduce the rate of posterior wall injuries compared with the conventional steep angle approach. The present study aimed to evaluate whether a difference in the angle of approach of the needle affects the rate of posterior wall injuries. The present study was a randomized crossover-controlled trial involving 40 medical residents, conducted in the clinical training center at a hospital with a residency program. The primary outcome measure was the rate of posterior vessel wall injuries. Subjects received a didactic lecture during which the instructors taught three SAX-OOP techniques including the conventional free-hand method (procedure C), a needle navigation system (procedure N), and a shallow puncture angle using a guidance system (procedure S). Participants were trained in these approaches under supervision and each technique tested in a simulation environment. Thirty-four of 40 residents had no previous experience with central venous catheterization and were included in the final analysis. The rate of posterior vessel wall injuries in procedure S (9%) was significantly lower than using the other approaches (procedure C, 53%; procedure N, 41%). In conclusion, a shallow angle of approach using the SAX-OOP technique resulted in significantly fewer posterior vein wall injuries in central venous catheterization compared with steep angle techniques.

Seldinger vs modified Seldinger techniques for ultrasound-guided central venous catheterisation in neonates: a randomised controlled trial

BackgroundCentral venous catheterisation in neonates is difficult. The purpose of this study was to compare the Seldinger and modified Seldinger techniques for ultrasound-guided internal jugular vein catheterisation in neonates. MethodsIn this randomised, controlled trial, 120 neonates (≤1 month old) requiring central venous catheterisation under general anaesthesia were allocated into either the Seldinger (n=60) or the modified Seldinger (n=60) group. The primary outcome was the incidence of successful catheterisation on the first attempt. We also assessed the incidences of successful puncture on the first attempt, successful guide wire insertion on the first attempt, and successful final catheterisation. ResultsThe primary outcome, the incidence of successful catheterisation on the first attempt was higher in the modified Seldinger group than in the Seldinger group (83% vs 65%; relative risk=1.282; 95% confidence interval, 1.032–1.594; P=0.025). The incidence of successful guide wire insertion on the first attempt was also higher in the modified Seldinger group (95% vs 75%; relative risk=1.267; 95% confidence interval, 1.082–1.482; P=0.003). Other incidences did not differ significantly between the groups. ConclusionsFor ultrasound-guided internal jugular vein catheterisation in neonates, the modified Seldinger technique showed superiority over the Seldinger technique in terms of successful catheterisation and guide wire insertion on the first attempt. Clinical trial registrationNCT02688595.

A Comparative Study of Complications in Ultrasound-Guided Central Venous Catheterization (Internal Jugular Vein Versus Subclavian Vein): A Prospective, Randomized, Multicenter Trial

Background: The use of ultrasound (US) has been suggested to reduce complications of central venous (CV) catheterization and to increase the safety and quality of CV catheter placement. However, complication rates have not been compared according to insertion points for CV catheterization using US. Accordingly, this study aimed to compare the complication rates of internal jugular vein (IJV) with those of subclavian vein (SCV) catheterization. Methods: A total of 1484 patients were preoperatively randomized into two groups. The internal jugular (IJ) group (n = 742) was cannulated via the right IJV, and the subclavian (SC) group (n = 742) was cannulated via the right SCV under US guidance. The primary outcome measure was total complication rate. Secondary outcomes included access time for the first attempt, number of attempts, and catheter position. Findings: The total complication rate did not demonstrate a significant difference between the IJ (0*1%) and SC (0*7%) groups (P = 0*248). In the IJ group, arterial puncture occurred in 0*1% of patients; in the SC group, arterial puncture occurred in 0*6% and pneumothorax in 0*1%. The access time for the first attempt (P < 0*001) and the average number of attempts were significantly lower (P = 0*006) in the IJ group than in the SC group. More catheter misplacements were observed in the SC group (5*9%) than in the IJ group (0.4%) (P < 0*001). Interpretation: Results demonstrated that complication rates in IJV and SCV catheterization using US are very low and are comparable. Clinical Trial Number: This trial is registered with ClnicalTrials.gov, number NCT01510743. Funding Statement: The authors report: There is no funding source. Declaration of Interests: All authors report no conflict of interest. Ethics Approval Statement: Institutional review board approval was obtained from the following centers: Seoul National University Bundang Hospital (Gyeonggi, Korea), Asan Medical Center (Seoul, Korea), and Boramae Medical Center (Seoul, Korea). Informed written consent was obtained from all patients before participation.

Endovascular Management of Iatrogenic Internal Jugular Vein-Subclavian Artery Fistula Formed by Inadvertently Misplaced Hemodialysis Catheter: A Case Report

: Right internal jugular vein catheterization is a way to establish a temporary dialysis vascular access. Arterial injuries including inadvertent arterial cannulation and/or arteriovenous fistula formation are one of the most clinically important complications of hemodialysis catheter placement. Endovascular management of these conditions is a promising treatment option, especially for aged and co-morbid patients. This report represents a case of internal jugular vein-subclavian artery fistula formed by inadvertently misplaced double lumen tunneled cuffed central venous catheter that was treated successfully with covered stent graft placement.

Three-step procedure for safe internal jugular vein catheterization under ultrasound guidance.

Real-time ultrasound guidance for central venous catheterization has become a standard technique. This technique has been reported to yield high success rates and fewer complications compared with landmark techniques. However, it can be risky when the practitioner does not possess proper knowledge and skills. Lose sight of the needle tip can lead to severe complications such as arterial puncture or pneumothorax. Also, posterior wall penetration of the target vessels must be avoided. Misplacement of the catheter to other vessels can sometimes occur, and may only be discovered after the catheterization procedure. To avoid these complications, we perform a three-step procedure to place an internal jugular vein catheter under ultrasound guidance. The three steps are: (a) advance the needle tip to the internal jugular vein with a short-axis image with an out-of-plane technique, (b) rupture the anterior wall by using a long-axis image with an in-plane technique, and (c) confirm the guidewire position from the internal jugular vein to the brachiocephalic vein using a short-axis image, and a coronal image from the supraclavicular fossa. For safe needle advancement and penetration of the anterior wall of the vein, combined use of short-axis and long-axis images is helpful, and guidewire placement should be confirmed by scanning with the short-axis image and the coronal image.

Availability of right femoral vein as a route for tunneled hemodialysis catheterization.

PurposeThis study was performed to investigate the primary patency rate and catheter-related problems associated with use of the femoral vein as a route for tunneled hemodialysis catheterization compared with those of the right internal jugular vein as the first-choice route in patients undergoing maintenance hemodialysis.Patients and methodsTwenty-two patients underwent placement of indwelling tunneled hemodialysis catheters in the right internal jugular vein as the first option for maintenance hemodialysis, and 20 patients underwent placement in the right femoral vein as the second option. The primary patency rate of the catheters and catheter-related problems at 1, 3, 6, and 12 months after placement were investigated.ResultsThe 1-, 3-, 6-, and 12-month primary patency rates of the tunneled hemodialysis catheters in the right internal jugular vein were 95.5%, 95.5%, 81.3%, and 58.3%. The primary patency rates of the catheters in the right femoral vein were 95.0%, 89.5%, 86.7%, and 66.7%. There were no statistically significant differences in the primary patency rates at 1, 3, 6, and 12 months or in catheter-related problems between the right internal jugular vein and right femoral vein.ConclusionThe primary patency rate and catheter-related problems of indwelling tunneled hemodialysis catheters placed in the right femoral vein were not different from those in the right internal jugular vein in patients undergoing maintenance hemodialysis. These results suggest that the right femoral vein might be a useful option for placement of indwelling tunneled hemodialysis catheters in patients undergoing maintenance hemodialysis.

Validation of the ipsilateral nipple as the needle directional guide during right internal jugular vein catheterization: A prospective observational study

The ipsilateral nipple has been used as a directional guide for needle advance during internal jugular vein (IJV) catheterization. We attempted to validate the utility of the ipsilateral nipple during IJV catheterization. One hundred and two patients scheduled for elective surgery were enrolled. In the 15° Trendelenberg position with 30° head rotation, the apex of the triangle formed by the sternocleidomastoid muscle and the clavicle was identified. The angle formed by the line connecting the apex and the ipsilateral nipple and the actual course of the IJV was measured. The distance between the apex of the anatomical triangle and the IJV center identified were measured via ultrasound. The angle formed by the line connecting the apex and the ipsilateral nipple and the IJV was 16±7.6° and was greater in females than males (14.8±1.1 vs 17.4±1.0°, P=0.043). Regression analysis showed that height, weight, gender, and age did not affect the angle as an independent factor. The apex of the anatomical triangle was 0.5cm medial to the IJV center and was shorter in females compared to males (0.33±0.12 vs 0.6±0.09cm, P=0.039). Our study shows that when the needle is inserted at the apex of the anatomical triangle directed towards the ipsilateral nipple, it crosses the IJV at 16°. Since the common carotid artery is usually medial to the IJV, directing the needle towards the ipsilateral nipple seems to be a safe way to avoid the common carotid artery and successfully puncture the IJV.

Unusual clot formation following insertion of central double lumen catheter for hemodialysis.

We report a case of a patient with chronic renal failure (CRF) due to fibrillary glomerulonephritis, who was admitted to our Hospital with fever accompanied by chills, of two days duration. Due to aggravation of his CRF, accompanied by severe metabolic acidosis, an internal jugular double lumen central vein catheter was inserted, through which he was hemodialyzed. Blood cultures were negative. The catheter was removed and the tip was cultured; it revealed colonization with hemolytic Staphylococcus sensitive to vancomycin and metilmycin. They were both given to the patient with excellent results. Trans-thoracic and trans-esophageal echocardiography revealed a clot in the right atrium with an abnormal circumference, connected to the tip of the second catheter. Anticoagulants were administered (calsium nadroparin, converted seven days later to acenocoumarol) and the size of the clot was significantly reduced. The case is presented in order to prove the significant contribution of trans-esophageal echocardiography as a non-invasive imaging technique for the detection of a clot in the right atrium and the impressive influence of appropriate therapeutic management in saving the patient's life and reducing the clot size. The trans-esophageal echocardiogram provides invaluable information concerning the evolution, development and regression of right atrium clots formed at the tip of jugular catheters.

4:03 PM Abstract No. 198 Comparison of infection and dysfunction risks of internal jugular versus femoral tunneled hemodialysis catheters

While there is robust data comparing outcomes for temporary catheters in the ICU based on insertion site, there is a paucity of literature on long-term catheters, which may be subject to different environmental and patient-related factors. Therefore, the purpose of this study was to compare rates of infection and dysfunction for tunneled hemodialysis catheters inserted via the femoral versus internal jugular veins. Review of our procedural database for tunneled hemodialysis catheter insertions in either the common femoral vein or internal jugular vein revealed a total of 544 patients (294 male, 250 female; mean age 55.6 years). Demographic information was recorded as well as presence or absence of comorbidities at time of catheter placement. The date and reason for removal or catheter exchange was ascertained from the medical records. The freedom-from infection or dysfunction intervals were calculated with the Kaplan-Meier technique and compared with the logrank test. Analysis was performed on 409 internal jugular vein catheters and 134 femoral catheters. There was no significant difference between the two groups in proportion of patients with diabetes, HIV, steroids, chemotherapy, or cancer. History of DVT/PE was present in 21% of patients with femoral catheters, vs 14% of patients with IJ catheters (p = 0.08). The median infection-free interval for IJ catheters was 363 days, compared with 174 days for femoral catheters (p = .007). The infection rate was 0.38 per 100 catheter days for the femoral group, compared with 0.20 for the IJ group. The mean dysfunction-free interval was 862 days for IJ catheters vs 520 days for femoral catheters (p = .09). The dysfunction rate was 0.21 per 100 catheter days for the femoral group, compared with 0.10 for the IJ group. The catheter-associated infection rate was significantly higher for patients with tunneled femoral hemodialysis catheters versus IJ catheters but with a similar dysfunction rate. However, the infection rate for femoral catheters is well within the acceptable rate for catheter-related infection.

Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis.

BackgroundA long-axis in-plane (LA-IP) approach and a short-axis out-of-plane (SA-OOP) approach are the two main approaches used in ultrasound (US)-guided vascular catheterization. However, the efficacy and safety of these approaches remain controversial. Therefore, we performed this meta-analysis to compare the two techniques in vascular catheterization.Materials and methodsRelevant studies were searched in PubMed, Embase, and the Cochrane Library databases from database inception until August 2017. Randomized controlled trials comparing a long-axis approach with a short-axis approach for US-guided vascular cannulation were selected. The RevMan software was used to analyze the results, and trial sequential analysis (TSA) was further applied to determine whether the currently available evidence was sufficient and conclusive.ResultsEleven studies met the inclusion criteria. Overall, 1,210 patients were included. The total success rate was similar between the SA-OOP and LA-IP approaches for US-guided vascular catheterization (risk ratio [RR], 1.01; 95% CI, 0.99–1.04; P=0.35; I2=48%). In the radial artery (RA; RR, 1.00; 95% CI, 0.96–1.05; P=0.88; I2=49%) and internal jugular vein (IJV; RR, 1.00; 95% CI, 0.98–1.02; P=0.99; I2=0%) subgroups, the total success rate was also similar and was confirmed by the TSA. For populations with subclavian vein (SCV) and axillary vein catheterization, the SA-OOP approach showed a benefit for first-attempt success rate. No significant differences in first-attempt success rate, cannulation times, or complications were found between the two approaches.ConclusionDespite a similar total success rate between the SA-OOP approach and the LA-IP approach when used for RA and IJV catheterization (as confirmed by TSA), further robust well-designed trials are warranted to evaluate other outcomes. There is insufficient evidence to definitively state that the SA-OOP approach was superior to the LA-IP approach when used for SCV and axillary vein catheterization. High-quality trials are needed to confirm or refute this finding.

Changes in the Internal Size of the Jugular Vein in Adult Patients with Hypovolemia.

The present study is aimed at establishing the values of internal jugular vein (IJV) anterior-posterior and medial-lateral sizes in patients with hypovolemia. A total of 25 adult Intensive Care Unit patients with hypovolemia were studied. It was found that the anterior-posterior vein size in patients with hypovolemia was significantly less than medial-lateral size during inhalation and during exhalation as well (P < 0.05). Besides, the value of the anterior-posterior size (Dmin) <7 mm was recorded in 20 from 25 patients (80%). At the same time, the medial-lateral size (Dmin) <7 mm was recorded only in six patients (24%). In patients with hypovolemia, the medial-lateral diameter of IJV is more than its anterior-posterior diameter. These data might be useful for justifying the benefits of using lateral access for IJV catheterization under ultrasound imaging in patients with hypovolemia.