Ultrasound-guided Internal Jugular Venous Catheterization Research Articles

Inadvertent catheter misplacement into the subclavian artery during ultrasound-guided internal jugular venous catheterization: a case report

BackgroundUltrasound-guided central venous catheterization has become a standard procedure. However, mechanical complications are still reported.Case presentationAn 85-year-old woman presented with coagulopathic bladder tamponade. Ultrasound-guided right internal jugular venous catheterization was planned because of difficult peripheral venous access. A guidewire was advanced through a needle inserted at the midpoint of the right carotid triangle. The guidewire was identified in the short axis, but not in the long-axis ultrasound view, leading to inadvertent insertion of the catheter into the right subclavian artery through the internal jugular vein. Stent graft insertion was performed for perforation closure. The patient exhibited no symptoms of cerebral ischemia following stent graft insertion.DiscussionThis case demonstrated that the needle-sticking site should not be placed close to the clavicle for ultrasound-guided internal jugular venous catheterization, as it may not confirm the position of guidewire in the long-axis ultrasound view.

Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial.

Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques. Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes. In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma. The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.

Shallow-angle needle guide for ultrasound-guided internal jugular venous catheterization: A randomized controlled crossover simulation study (CONSORT).

Needle guides for ultrasound-guided internal jugular venous catheterization facilitate successful cannulation. The ability of a needle guide to prevent a posterior vein wall injury which may secondarily induce lethal complications, is unknown. Previous studies showed that a shallow angle of approach may reduce the incidence of posterior wall injuries. We developed a novel needle guide with a shallow angle of approach for ultrasound-guided venous catheterization and examined whether this needle guide reduces the incidence of posterior wall injuries compared to a conventional needle guide and free-hand placement in a simulated vein. This study was a randomized crossover-controlled trial. The primary outcome was the rate of posterior vein wall injuries. Participants had a didactic lecture about three ultrasound-guided techniques using the short-axis out-of-plane approach, including free-hand (P-free), a commercial needle guide (P-com), and a novel needle guide (P-sha). The view inside a simulated vein was recorded during venipuncture. Thirty-five residents participated in this study. Posterior vein wall injuries occurred in 66% using P-free, 60% using P-com, and 0% using P-sha (p< 0.01). There was no significant difference in the incidence of posterior vein wall injuries between P-free and P-com. Use of a shallow angle of approach needle guide resulted in a lower rate of posterior vein injuries during venipuncture of a simulated vein compared with other techniques using a steeper angle techniques.

Comparing short-, long-, and oblique-axis approaches to ultrasound-guided internal jugular venous catheterization: A meta-analysis of randomized controlled trials.

Internal jugular venous catheterization is performed for numerous therapeutic interventions. Although ultrasound-guided internal jugular venous catheterization is the gold standard for this procedure, complications can still occur. Various scanning axes, namely, the short axis (SA), long axis (LA), and oblique axis (OA), have been developed to ameliorate these complications. This study compared the efficacy and safety of SA, LA, and OA approaches. PubMed, Embase, and Cochrane Library databases were searched for studies published before September 2018. Only randomized controlled trials were included. We conducted meta-analyses using a random-effects model. Treatment efficacy was measured by total success rate, first-pass success rate, number of needle passes, and incidence of complications, namely, arterial puncture, hematoma, and catheter-related bloodstream infection. Six randomized controlled trials with 621 patients were included. No significant differences were observed in total success rate and first-pass success rate, as well as in the arterial puncture, hematoma, or catheter-related bloodstream infection complications between SA and LA approaches. Moreover, no significant difference was found between SA and OA approaches in terms of total success rate, first-pass success rate, number of needle passes, and complications of arterial puncture and hematoma. However, the number of needle passes was significantly fewer in SA approach than in LA approach (weighted mean difference, -0.18; 95% confidence interval, -0.35 to -0.01). None of the scanning axes exhibited unique features that could enhance their suitability for application. Hence, scanning axes should be selected by considering various factors that include patient characteristics, clinician expertise, and ease of procedures. Systematic review and meta-analysis, level I.

The success rate and safety of internal jugular vein catheterization under ultrasound guidance in infants undergoing congenital heart surgery.

In this study, we aimed to investigate the effect of central venous catheterization under ultrasound guidance on the success and complication rates in low-weight infants (under 5 kg) undergoing surgery due to congenital heart disease. A total of 70 infants (38 boys, 32 girls; mean age of patients <1 month was 16.4±9.5 days [n=20; 28.6%]; 1-7.5 months was 126.3±47.8 [n=50; 71.4%]) who underwent ultrasound-guided internal jugular venous catheterization between October 2014 and October 2015 were retrospectively analyzed. All catheterizations were done under the guidance of ultrasound by two skilled anesthesiologists. Data including demographic characteristics of the patients, procedural success rate, catheter access time, number of attempts, and complications were recorded. The overall success rate of the procedure was 92.8% (n=65). In 82% of the patients (n=53), the insertion was successful at the first attempt. The mean catheter access time (time from the first puncture to the catheter insertion) was 214±0.48 sec. Complications were seen in five patients (7.14%), and the body weight of these patients was less than 2,500 g. There was no arterial puncture in any patients. One patient (1.42%) developed pneumothorax and four patients (5.7%) developed hematoma due to repeated attempts. Our study results suggest that ultrasound-guided central venous cannulation is a safe and effective technique in pediatric population weighing less than 5 kg undergoing congenital heart surgery.

A 45° Set Square Method for Accurate Needle Insertion in Ultrasound-guided Internal Jugular Venous Catheterization

Until now, there was no standardized method for insertion of introducer needle in ultrasound-guided internal jugular venous catheterization (IJVC). The needle insertion site and angle have been determined on the basis of the performer's experience. We designed a new standardized approach (called 45° set square method) that determines the site and the angle of needle insertion during ultrasound-guided IJVC to improve first-attempt success rate and reduce complications. The purpose of this study was to investigate the clinical usefulness of the novel 45° set square method for IJVC by ultrasound guidance in the Emergency Department (ED).

Factors Associated with Acute Kidney Injury in Patients after Cardiac Arrest Treated with Therapeutic Hypothermia

(60%) in overall success rate within three attempts (p = 0.001) and the number of attempts (p < 0.001). There were significant differences between the two groups in puncture time (p = 0.004), hematoma (p = 0.048), and technical difficulty score (p < 0.001). Conclusions: The 45 set square method is an effective and safe method for ultrasound-guided internal jugular venous catheterization in the ED.