Internal Jugular Group Research Articles

Rate of various access sites for temporary transvenous pacing and different outcomes at Lady Reading Hospital, Peshawar Pakistan.

To evaluate the various temporary transvenous pacemaker (TPM) access sites, its indications, procedural complications, and outcomes of patients. This prospective study conducted in a tertiary care hospital of Peshawar, included 100 patients, who underwent TPM for any reasons, via the trans jugular, subclavian, or trans-femoral route. The duration of the study was from October 1st, 2021 to March 31st, 2022. The demographic, procedure -related complications, causes of complete heart block and in hospital outcomes were recorded. Of the 100 patients who underwent temporary transvenous pacing, 56%were males and 44% were females, with an age range of 46-80 years. In majority of the patients, (N =54) internal jugular vein was used as the venous access site followed by the subclavian vein. (N=24). Coronary artery disease was prevalent in 42% of the patients. 50% had complete AV block, 19% had symptomatic second-degree block, and 10% had sinus nodal diseases. Seventy three percent of the patients needed TPM implantation on an emergency basis, which is statistically significant (p=0.009). Almost 40% of the patient ultimately underwent a permanent pacemaker. Out of 100 patients, 16 patients expired. The major procedure related complications were bleeding 16% overall at the puncture site and 14.8% in the internal jugular group. Other complications were local infection 13% at the insertion site followed by hemopericardium 3%, in the internal jugular group. Atrioventricular block is the commonest indication for temporary pacing in our study. The average time the TPM remained in place was significantly higher in the trans jugular approach group along with a higher complication rate in this group.

THE RETURN OF SUBCLAVIAN CANNULATION IN THE CRITICAL CARE SETTING: A WESTERN CRITICAL CARE EXPERIENCE

THE RETURN OF SUBCLAVIAN CANNULATION IN THE CRITICAL CARE SETTING: A WESTERN CRITICAL CARE EXPERIENCE

Effect of access site choice on inferior vena cava filter angulation and outcomes

BackgroundIn the present study, we compared the outcomes of inferior vena cava (IVC) filter placement between the femoral vein (FV) and internal jugular (IJ) vein access sites. MethodsWe performed a retrospective study using the Vascular Quality Initiative database to assess patients who had undergone IVC filter placement from 2013 to 2019. The patients were placed into two groups according to the access site location: FV and IJ vein. The FV group included patients with access via the right and left FVs and other leg veins, and the IJ group included patients with access via the right or left IJ vein. The primary outcome was the rate of filter angulation. The secondary outcomes included access site complications such as deep vein thrombosis, hematoma, and bleeding requiring transfusion. ResultsOf 13,221 patients, 8214 (63%) had undergone IVC filter placement via FV access and 4789 (37%) via IJ access. The remaining 218 patients had had an unknown access site or were excluded. Within the IJ group, 4696 (98.0%) had undergone access via the right IJ and 93 (2%) via the left IJ. Within the FV (common femoral, femoral, or other infrainguinal veins) group, 7007 (85.3%) had undergone access via the right FV and 1207 (14.6%) via the left FV. The mean patient age was 63 ± 15.9 years, the mean body mass index was 30.9 ± 9.60 kg/m2, and 6788 of the patients were men (52.0%). The most common indication for filter placement was a contraindication to anticoagulation because of a recent or active bleeding episode (30%), followed by planned surgery (22%), new deep vein thrombosis/pulmonary embolism (7%), fall risk (5%), and trauma (4%). Infrarenal filters had been placed in 97.9% of the patients. Univariate analysis identified body mass index and suprarenal placement as independent risk factors for angulation. The final multivariate analysis showed a significant increase in angulation (0.9% vs 0.34%; odds ratio, 1.46; 95% confidence interval, 1.02-2.11; P = .04) and increased access site complications (0.25% vs 0.07%; odds ratio, 2.068; 95% confidence interval, 1.01-4.23; P = .048) in the FV access group. No significant correlation between the access site and retrieval rate was found (P = .9270). ConclusionsPlacement of IVC filters via IJ access showed a lower rate of filter angulation in the IVC and fewer access site complications compared with FV access.

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.

A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients

Introduction and aims The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons. Alternative settings for the introduction of totally implantable venous access devices (TIVAD) and the search for lower rates of morbidity led to the choice of other central veins. This study compares two different venous accesses, the subclavian (SC) versus the internal jugular (IJ), in terms of early and late morbidity. Patients and methods This is a prospective, non-randomized, observational, uni-institutional (tertiary cancer centre) study. From March 2003 to March 2006, 1231 TIVADs were placed (1201 patients), in an ambulatory operating room, under vital signs and EKG monitoring, using local anaesthesia and without perioperative radiological control. Results Of the 1231 TIVAD, 617 were inserted via the SC and 614 via the IJ vein. The two groups (SC vs. IJ) were comparable as to general patient characteristics. Immediate complications were more frequent in the SC than in the IJ approach (respectively, 5.0% vs. 1.5%; p < 0.001); Catheter malposition occurred in 2.3% when using the SC vein and in 0.2% for the IJ ( p = 0.001). Long term morbidity was also more frequent in the SC than in the IJ group (respectively, 15.8%, 87/551, vs. 7.6%, 39/512; p < 0.001). Venous thrombosis developed in 2.0% of patients with an SC TIVAD as compared to 0.6% with an IJ TIVAD ( p = 0.044). Catheter malfunction was significantly dependent on the vein used: SC - 9.4% vs. IJ - 4.3% ( p = 0.001). Conclusions Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD.

1589 POSTER Occlusion in totally implantable vascular access devices: what is its incidence and what actions do nurses take to restore patency?

The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons. Alternative settings for the introduction of totally implantable venous access devices (TIVAD) and the search for lower rates of morbidity led to the choice of other central veins. This study compares two different venous accesses, the subclavian (SC) versus the internal jugular (IJ), in terms of early and late morbidity.This is a prospective, non-randomized, observational, uni-institutional (tertiary cancer centre) study. From March 2003 to March 2006, 1231 TIVADs were placed (1201 patients), in an ambulatory operating room, under vital signs and EKG monitoring, using local anaesthesia and without perioperative radiological control.Of the 1231 TIVAD, 617 were inserted via the SC and 614 via the IJ vein. The two groups (SC vs. IJ) were comparable as to general patient characteristics. Immediate complications were more frequent in the SC than in the IJ approach (respectively, 5.0% vs. 1.5%; p < 0.001); Catheter malposition occurred in 2.3% when using the SC vein and in 0.2% for the IJ (p = 0.001). Long term morbidity was also more frequent in the SC than in the IJ group (respectively, 15.8%, 87/551, vs. 7.6%, 39/512; p < 0.001). Venous thrombosis developed in 2.0% of patients with an SC TIVAD as compared to 0.6% with an IJ TIVAD (p = 0.044). Catheter malfunction was significantly dependent on the vein used: SC - 9.4% vs. IJ - 4.3% (p = 0.001).Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD.

Comparison of Central Venous Catheterization Sites in Infants

This study aimed to compare the rates of success and complications between different sites of central venous catheterization in infants. A total of 272 infants were randomized to four groups: right subclavian group (G-RSCV), right internal jugular group (G-RIJV), left subclavian group (G-LSCV) and left internal jugular vein group (G-LIJV). In 77.2% of the patients, we successfully introduced a catheter at the first attempt. The rate of successful catheter placement was highest in the and LSCV 55.9%). With regard to complications, the rate of arterial puncture, guide wire advancement failure and malpositioning of the catheter were all significantly more frequent during SCV catheterization (SCV versus IJV: 10.1% versus 2.1%, 12.4% versus 0% and 13.4% versus 0.6%, respectively). Our results imply that IJV, especially RIJV, should be the first choice for central venous catheterization in infants.

Central venous cannulation in patients with liver disease and coagulopathy--a prospective audit.

To determine the incidence of vascular complications associated with central venous cannulation in patients with liver disease and coagulopathy. A prospective audit of all cannulation episodes in patients with liver disease and a prothrombin (INR) more than 1.5 and/or platelet count of 150 x 10(9)/l or less. A specialist liver unit between January 1996 and September 1997. Patients with acute or chronic liver diseases and patients undergoing liver transplantation or other hepatobiliary surgery. Vascular complications of central venous cannulation were classified as major (any haemodynamically significant haemorrhage) or minor (superficial oozing or haematoma). We recorded 658 cannulations (subclavian, 352, and internal jugular, 306). The median INR was 2.4 (range 1-16) in the subclavian group and 2.7 (1-17) in the internal jugular group (p < 0.05); median platelet counts were 81 x 10(9)/l (range 9-1088) and 83 x 10(9)/l (10-425), respectively (difference not significant). One patient developed a haemothorax after accidental subclavian artery puncture (INR was 1.5, platelets 68 and regional prostacyclin therapy was being given for haemofiltration). There were no other major vascular complications. Risk factors for minor vascular complications included internal jugular cannulation, more than one needle pass into the vein, failure to pass any guidewire, a high INR and low platelets for haematoma formation, and low platelets and heparin therapy for superficial oozing. The incidence of major vascular complications following central venous cannulation in patients with liver disease and coagulopathy was low in this audit. In liver disease the presence of a raised INR alone should not be considered a contra-indication to central venous cannulation.

Acute complications of central line placement in profoundly thrombocytopenic cancer patients

Morbidities associated with the insertion of central venous catheters in severely thrombocytopenic cancer patients were analyzed in this prospective observational study. One hundred fifteen consecutive thrombocytopenic patients requiring central venous access (internal jugular or subclavian vein cannulation by a modified Seldinger technique) were evaluated. One hundred fifteen catheters were inserted. For each patient, the following factors were documented: age; sex; diagnosis; previous catheterization; prior neck, chest, breast, or axillary surgery or radiation therapy; presence of other lines prior to venipuncture; site and indication for line insertion; complications; PT and PTT; platelet counts; and hematocrit. Of the total number of catheters inserted, 63 (55%) were subclavian and 52 (45%) were internal jugular. Successful cannulations with no complications (n = 91; 79% of the total) were achieved with 1.2 +/- 0.5 attempts. Twenty-four major and minor complications (20%) occurred with an average of 1.6 +/- 1 attempts (P = 0.003). The mean preprocedure platelet counts were 14.8 +/- 4.5 x 10(9)/L for the subclavian group and 14.3 +/- 4.8 x 10(9)/L for the internal jugular group. With platelet transfusion, the mean postprocedure platelet counts for the subclavian and internal jugular groups were 23.9 +/- 12.8 x 10(9)/L and 24.6 +/- 15 x 10(9)/L, respectively. In the subclavian group, seven patients (6%) experienced minor complications. There were 17 minor complications (15%) and 1 pneumothorax in the internal jugular group. Patients experiencing more than one attempt at cannulation had more complications (P = 0.003). With the appropriate precautions and platelet transfusions, central venous catheters can be inserted safely with minimal complications into thrombocytopenic cancer patients. Fewer attempts are associated with fewer complications. High risk procedures should be attempted only by experienced personnel or under their direct and strict supervision.

Surgical Procedure and Indications for the Cervical Lymph Node Metastasis of Oropharyngeal Cancer and Laryngeal Cancer

We observed the results of neck dissection on oropharyngeal and laryngeal cancer for the last 15 years, and report on the modified technique for neck dissection procedure, boundaries of the lymph node groups removed, and elective dissection. First, based on cases of neck dissection on oropharyngeal cancer, we showed how we decide whether a redical or a modified neck dissection procedure would be taken. Next, we calculated the frequency of positive pathological metastasis cases by lymph node group, and a certain pattern could be observed. We found that if the oropharygeal cancer was located on the lateral wall, the internal jugular group and posterior triangular group of the affected side, and the contralateral upper jugular group should be dissected. In the same way, if the oropharyngeal cancer was located on the anterior wall, the bilateral internal jugular group should be dissected. In the case of a supraglottic laryngeal cancer, the bilateral internal jugular group, and the case of glottic laryngeal cancer, the internal jugular group of the affected side as well as the paratracheal area should be dissected respectively. For the indication of elective dissection, we observed the pathological metastasis frequency of laryngeal cancer . Here, we reached the conclusion that the indication was necessary in cases of advanced supraglottic laryngeal cancer, and for residual and recurrent cases over T2 or above which underwent radiotherapy.

Post Catheterisation Vein Stenosis in Haemodialysis: Comparative Angiographic Study of 50 Subdavian and 50 Internal Jugular Accesses

From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for 50 (first group) and by internal jugular catheter for the 50 others (second group). These two groups were not statistically different as regards age (61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second), sex (48% and 56% were women), duration of catheter insertion (31 +/- 21.8 and 31.7 +/- 16 days), and the number of dialysis sessions (13.5 +/- 9.1 and 13.6 +/- 7.1). The type of catheters, the frequency of removal for poor flow (16% in both groups) or infections (6% in both groups), and the local nursing were similar in the two groups. The only difference was the side of cannulation: the right side in 58% of cases in group 1 and 78% in group 2. The angiographic study revealed a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority over the subclavian route is asserted in respect of venous access of dialysed patients.