Internal Jugular Vein Puncture Research Articles

Is a Neutral Head Position as Effective as Head Rotation During Landmark-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial

Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn. A prospective, randomized, controlled study. An education and research hospital and a university-affiliated hospital. Eighty patients requiring central venous catheterization in the right IJV. Under general anesthesia, patients were positioned in the Trendelenburg position with extension of the neck. In the rotated group, the head was rotated to the left at >45°. In the neutral group, the head was placed in the neutral position. Right IJV cannulation was performed using the central approach with the needle angled toward the ipsilateral nipple. The primary outcome variable was the cumulative success rate, which was defined as IJV puncture achieved in the first 3 attempts using a finder needle. A p value of <0.05 was considered statistically significant. Groups were similar in terms of demographic data. The success rates of finder needle passes into the IJV on the first attempt were 87.5% and 37.5% (p < 0.05), and the cumulative success rates on the first 3 attempts were 97.5% and 57.5% in the rotated and neutral groups, respectively (p < 0.05). Carotid artery puncture only occurred in 2 patients in the rotated group. Because of the lower success rate, the neutral head position is not an attractive alternative for IJV catheterization when compared with the rotated head position in a central landmark IJV approach.

Effect of using StatLock in fasten the catheters of central vena in internal jugular vein puncture

Objective To investigate the application of StatLock and 3M films to fasten the catheters of central vena (CVC) in internal jugular vein puncture with ultrasonic guidance.Methods 109 brain cancer patients underwent CVC between March and May 2012 in the department of neurosurgery were randomly divided into the observation group (52 patients) and control group (57 patients).The catheters in the control group were fastened with 3M films.The observation group was fatened with both StatLock and 3M films.Then comparison was made between these two groups by dislocation of the catheters,adverse reactions around the puncture site and comfortable degree in care.Results The incidence of CVC dislocation and adverse reactions around the puncture site in the observation group were lower than the control group (7.69％ and 1.92％ vs 28.07％ and 15.79,x2 =7.54 and 4.72,respevtively; P ＜ 0.05).The comfort degree in care of the observation group was higher than that of the control group (94.23％ and 78.95％,x2 =5.53,P ＜0.05).Conclusions The application of StatLock and 3M films to fasten the catheters lowers the dislocation rate of CVC and the incidence of adverse reaction around the puncture site.It raises patients' comfort degree. Key words: Cerebral tumor; CVC; 3M films; StatLock; Fasten

Optimal shoulder roll height for internal jugular venous cannulation: a study of awake adult volunteers

Study ObjectiveTo explore the influence of shoulder roll height on internal jugular vein (IJV) diameter and IJV/common carotid artery (CCA) overlap. DesignCross-sectional study. SettingUniversity-affiliated hospital. Patients40 healthy participants. MeasurementsUltrasonography to measure the effects of using shoulder rolls ranging between 0 and 5 cm high on IJV diameter, CCA diameter, and percentage overlap of the CCA. Main ResultsThe percentage overlap of CCA decreased for both left (LIJV) and right IJV (RIJV) with the use of higher shoulder rolls. Greater values were seen in depth from skin surface to anterior wall of left IJV in almost all stages, with the exception of Stages 0 and 1 (P < 0.016); and the use of a 5 cm shoulder roll resulted in a significantly decreased anteroposterior (AP) diameter of both RIJVs and LIJVs (both P < 0.008). ConclusionsShoulder rolls can reduce the overlap between the IJV and CCA, and may be useful in positioning patients for IJV puncture.

A Safe and Efficacious Alternative: Sonographically Guided Internal Jugular Vein Puncture for Intracranial Endovascular Intervention

Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.

The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking

BackgroundCannulation of the internal jugular vein (IJV) is traditionally performed using the central-longitudinal approach. Pneumothorax, carotid artery puncture, and failure to cannulate are uncommon, but by no means rare, complications. Ultrasound (US) guidance for IJV cannulation has reduced but not eliminated such complications. TechniqueWe herein introduce a new approach, coined the “medial-transverse approach” due to the perpendicular angle at which the introducer needle is advanced toward the IJV from the median to lateral direction. DiscussionThe direction of the introducer needle is not toward the lung, thus virtually eliminating the possibility of pneumothorax. The image of the entire needle is seen when the US probe is typically orientated for a short-axis view of the IJV and carotid artery, thus improving the chance of uncomplicated IJV puncture. We have used this technique with apparent success in thousands of cases over the past 20 years in two different institutions. ConclusionA modified IJV cannulation technique that seems to have unique advantages over traditional approaches has been described. This technique is compatible with the blind and US-guided approaches.

Managing Complications of the Misplaced Central Venous catheter

IntroductionCentral venous catheters are an integral part of the management of the acutely unwell patient but their use is not without risks. ReportAn 11F double lumen central venous catheter was inadvertently placed into the vertebral artery when the landmark technique was used to obtain an internal jugular vein puncture. The patient required a sternotomy for adequate exposure, and the vertebral artery was ligated. DiscussionThis case demonstrates a rare complication of large bore central venous catheterisation requiring major open surgical repair and is the first reported case of an 11F catheter placed in the vertebral artery requiring surgical ligation.

Long‐term complications in totally implantable venous access devices: Randomized study comparing subclavian and internal jugular vein puncture

This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.

The efficacy of guidewire preset technique for internal jugular vein puncture and insertion of guidewire as compared to conventional technique

Hamamatsu University School of Medecine, Department of Anaesthesiology and Intensive Care, Hamamatsu, Japan

Acesso venoso central guiado por ultrassom: qual a evidência?

In recent years, international health quality assurance organizations have been recommending ultrasound guidance for central venous punctures. This article reviews the evidence behind these recommendations. The MEDLINE, PubMed and SCIELO databases were searched for the following MeSH terms: central venous access, ultrasonography, and adults. The search was conducted on September 24, 2010, and selected meta-analyses, randomized clinical trials and reviews, retrieving 291 papers. The 21 most important papers were analyzed in this review. The internal jugular vein is the most studied ultrasound-guided puncture site, with meta-analysis showing lower relative risks of failure and complications. In addition, the largest available randomized clinical trial demonstrated a reduced central venous catheter-associated blood stream infection rate. There are few studies involving subclavian vein puncture; however, ultrasound was shown to be beneficial in two meta-analyses (however, with small numbers of patients). Regarding the femoral venous site, only one randomized clinical trial (20 patients) was identified, showing positive findings. In a British cost-effectiveness study, ultrasound use lead to resource savings for different sites of venous puncture. There is strong evidence for ultrasound benefit for internal jugular vein puncture. Although the method appears attractive for the other sites, the data are not sufficient to support any recommendation.

Intra-Operative Blood Sampling: External Jugular Venous Access Can Reduce the Need to Insert Arterial Lines

Arterial lines (A-lines) are sometimes inserted for the primary purpose of enabling intra-operative blood sampling for both clinical and research needs. I suggest that in many patients in whom the only reason why an A-line is inserted is for intra-operative blood sampling, an IV inserted into the external jugular vein (EJ) may be an effective, and arguably a superior, alternative. After institutional approval, my last 40 cases where an EJ was placed for blood sampling (all were femoral-popliteal bypass or similar vascular cases under general anesthesia with positive pressure ventilation and 4-5 cm PEEP) were reviewed. In all cases, we were successful in withdrawing blood for repeated blood sampling (e.g., activated clotting times, hemoglobin/ hematocrit, glucose, potassium, venous blood gases). The longest case was approximately 4 hours in duration. In no case was it necessary to increase PEEP nor to put the patient in the Trendelenberg position to facilitate blood sampling. Four cases had 16g IVs, the remainder had 18g IVs. There were no complications noted. Although not in this review, we’ve successfully used an EJ for parathyroid hormone sampling during a parathyroidectomy. This communication is not intended to be a direct comparison of A-lines vs EJs. The goal is to bring to the attention of the readership an alternative technique for intraoperative blood sampling. With a virtual 100% success rate for drawing blood from an EJ, it would seem that the EJ would be at least as effective as an A-line for obtaining blood samples. Compared with a peripheral intravenous line (IV), A-lines may be more difficult to establish, are associated with rare but potentially severe vascular complications, and incur greater financial cost. Potential complications of an EJ insertion include carotid artery puncture, internal jugular vein puncture, hematoma formation, and air embolus. Further study is required to compare the complication rates of A-lines vs. EJs.

Ultrasound simulation of internal jugular vein cannulation in pregnant and non-pregnant women

Pregnancy alters the anatomic landmarks for internal jugular vein (IJV) cannulation. In this study, IJV cannulation was simulated, and success of the technique was evaluated using ultrasound. Term pregnant women and non-pregnant female volunteers were recruited. The degree of difficulty in assessing neck anatomy was noted. The optimal insertion points for cannulation were marked on the skin of each subject according to the central landmark and palpatory techniques. The midpoint of a 15-10MHz linear transducer was placed over each insertion point, and the vertical cursor of the ultrasound, which represented the path of the needle, was placed in the image. The outcome was an IJV puncture, a carotid artery (CA) puncture, or a missed attempt. One hundred and sixty-one women, 99 pregnant and 62 non-pregnant, were studied. The identification of landmarks was more difficult in pregnant women (P=0.01). The rates of successful IJV punctures, CA punctures, and missed attempts did not differ significantly between pregnant and non-pregnant women. Carotid artery punctures using the central landmark technique in pregnant and non-pregnant subjects were 19% and 10%, respectively. Corresponding figures for the palpatory approach were 6% and 3%, respectively. The degree of IJV overlap of the CA in the palpatory technique was greater in pregnant women (38% vs 18% showed>75% overlap; P<0.001), a difference that remained after controlling for body mass index The IJV overlies the CA to a greater extent in pregnant patients than in non-pregnant patients. Thus, a landmark approach for IJV cannulation might expose pregnant women to a greater risk of carotid puncture. This trial was registered at www.clinicaltrials.gov (NCT T00464828).

Ultrasound-guided insertion of pulmonary artery catheter: Case report

This is a case report of a 17-year old girl, who presented with aortic valve regurgitation and patent ductus arteriosus, and she underwent aortic valve replacement (AVR) and (PDA) ligation. Because of the extensive thrill and pulsation in the neck due to carotid artery dilatation, pulmonary artery catheter (PAC) was inserted under ultrasound guidance. This case report is to encourage the use of ultrasound for the safe puncture of internal jugular vein for the insertion of central line and PAC, particularly in the case of aortic valve regurge patients where carotid artery dilatation expected.

Radiographic Features of Malpositioning of a Hemodialysis Catheter in the Azygos Vein

Radiographic Features of Malpositioning of a Hemodialysis Catheter in the Azygos Vein

Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein-Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.

Modified anchoring maneuver using pilot puncture needle to facilitate internal jugular vein puncture for small children

Internal jugular vein (IJV) cannulation in infants has been reported with varied success using surface landmark. The aim is to share authors experience of modified anchoring technique used in infants. Anchoring maneuver using pilot needle (PN) has been recently described in adults. We have found that if the PN is left in IJV and then i.v. cannula (22G or 24G) is passed just posterior to the puncture point of PN to track down the PN path at 10-20 degree angles from skin, a natural tumbling movement of the PN helped to anchor anterior wall of IJV and facilitated its puncture. The results of 128 punctures performed in infants (<1 years) were analyzed in two groups of <6 months (n = 52) and >6 months to 1 year (n = 76). In infants weighing 3.5-14 kg, all cannulations were performed successfully. IJV puncture was detected at the entry of i.v. cannula more often in both the groups (81% in <6 months baby and 84% in >6 months baby) than withdrawing it. In 12 (10%) patients, the puncture site was changed to left IJV as carotid artery was punctured in three and failure to localize right IJV in nine patients by surface landmark. In authors experience, the described technique detected IJV cannulation at its entry in majority of infants and so the method is less prone to complications related to overshooting of the needle in lack of IJV puncture detection.

Ultrasound evaluation of techniques for internal jugular vein puncture in children

To determine by ultrasound which access and position the child must stay to obtain the best transversal section of the right Internal Jugular Vein (RIJV) allowing a safer puncture. Three possible accesses to the RIJV, anterior, lateral and posterior, from 57 healthy children, were analyzed through ultrasound images in a sequence of positions of the head, in supine position, with or without a roll under the scapula: head centered in neutral position with and without a roll (NPP and NP); contra lateral rotation with and without a roll (CLRP and CLR), neutral position and the patient raised in 30 degrees in Trendelenburg position (TDG). To analyze the results it was applied one statistic method, with variation analysis to the same individuals. Ultrasound evaluation in each one of the proposed positions. The statistical analysis of the results observed that the lateral puncture with the patient in the neutral position, in Trendelemburg without a roll, offers a bigger area in comparison to all the other options of puncture and positioning of the patient (p<0, 0001). The safer way for the puncture of RIJV in children is obtained in neutral position in Trendelemburg by lateral puncture, without a shoulder roll.

Is it More Difficult to Cannulate the Right Internal Jugular Vein in Morbidly Obese Patients than in Nonobese Patients?

The placement of an internal jugular vein (IJV) catheter is considered to be more difficult in morbidly obese patients. The objective of this study was to compare the success of simulated IJV puncture between morbidly obese patients and a nonobese control group. Thirty-four morbidly obese patients with body mass index (BMI, kg/m(2)) >/=40 were compared with 36 patients with BMI < 30. Right IJV puncture was simulated using an ultrasound probe directed towards the sternal notch at the midpoint between the sternal notch and the mastoid process. The investigator placing the probe was blinded as to the image being created on the ultrasound machine. Success rate was assessed at three different head rotation angles from midline; 0 degrees , 30 degrees , and 60 degrees . There was no statistically significant difference in successful simulated IJV puncture between two groups for any of the head positions. However, there was a higher incidence of the carotid artery (CA) puncture in the morbidly obese patient group when the head rotation was advanced from neutral position to 60 degrees (p < 0.05). In addition, the ultrasound showed significantly more overlapping of the IJV over the CA in morbidly obese patients at 0 degrees (p < 0.05) and 30 degrees (p < 0.05). Our results show no statistically significant difference in success rate of IJV puncture between morbidly obese patients and nonobese patients. Keeping the head in a neutral position in morbidly obese patients minimizes the overlapping of the IJV over the CA and the risk of CA puncture. However, due to the fact that even in the neutral position there is a significant increase in overlap between IJV and CA, we recommend the use of ultrasound guidance for IJV cannulation in obese patients.

Meta analysis of two approaches for central venous catheterization through deep vein puncture

Objective The incidence rate of complication during central venous catheterization through internal jugular vein (IJV) and subclavian vein (SV) puncture. Methods Clinical controlled trials about IJV and SV puncture were collected and related literatures were screened according to the criteria of inclusion. The literatures underwent Meta analysis and subsequent analysis of sensitivity. Results A total of 18 literatures were included. Meta analysis indicated that statistical difference existed in the related infection rate [RR=1.74, 95%CI (1.32, 2.30)] and arterial puncture [RR=3.19, 95%CI (1.70, 5.99)], but not in the one-time-puncture success rate [RR=1.06, 95%CI (0.90, 1.24)] between IJV and SV puncture. Conclusions The rate of related infection and arterial puncture was higher by IJV than by SV puncture. But we could not confirm if any difference existed in the one-time-puncture success rate between the two methods. The results still needs evaluation by high-quality randomly controlled experiments. Key words: Internal jugular vein puncture; Subclavian vein puncture; Central venous catheterization

Drift of needle during internal jugular vein puncture and insertion of guide wire

Drift of needle during internal jugular vein puncture and insertion of guide wire

Transjugular liver biopsy using ultrasonographic guidance for jugular vein puncture and an automated device for hepatic tissue sampling: a retrospective analysis of 200 consecutive cases

We retrospectively evaluated the value of the combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for transjugular liver biopsy. Transjugular liver biopsy was performed with ultrasonographic guidance for right internal jugular vein puncture and an automated device for hepatic tissue sampling (Quick-Core) in 200 consecutive patients in whom percutaneous transhepatic biopsy was contraindicated. Histopathologic specimens were reviewed for adequacy and complications related to the procedure were analyzed. Biopsies were technically successful in 198 of 200 (99%) patients. The two cases of technical failure were due to an acute angle between right hepatic vein and inferior vena cava (1%). Adequate gross hepatic tissue specimens (mean length, 11. 0 mm +/- 5.3; range, 5.0-20.0 mm) were obtained in 198 (99%) patients, allowing definitive histological diagnosis in 196 of 198 patients, for an overall success rate of 98%. Neither cases of inadvertent injury of the carotid artery nor life-threatening intraperitoneal bleeding were observed. Minor complications were noted in 24/200 (12%) patients. The combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for tissue sampling is recommended for transjugular liver biopsy as it results in a safe, well-tolerated, and efficient technique.