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Background:Central venous catheterization is a vital intervention in critically ill patients. The purpose of this study was to compare the procedural parameters and complications associated with anterior and posterior approaches of IJV catheterization under real timeultrasound guidance in critically ill patients. Material And Methods:In this prospective randomised study, 90 patients admitted in various ICUs were randomly allocated two groups of 45 each, including both males and females aged between 18 to 80 years ofage requiring central venous catheterization for various indications. Result:The first attempt success rates were comparable between both the groups. The venous visualization time was 38.52 seconds in Group A and 14.65 seconds in Group P (p<0.001). The venous puncture time and the duration of catheterization was found to be 47.60 sec & 2 minutes in Group A respectively and 24.16 sec & 1 minute 32 sec in Group P respectively (p<0.001). No statistically significant differences were found between the two groups in terms of incidence of carotid arterial puncture, haematoma formation and catheter displacement.Conclusion:It was observed that the posterior approach is better than anterior approach of USG guided IJV catheterization as it improves the accuracy, reduces the access time and duration of catheterization & leads to fewer incidences of immediate complications like carotid arterial puncture & subseque nt haematoma formation.
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Abstract Background and objectives: Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to improve significantly the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique: The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach - the "Syringe-Free" approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions: The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure.
Resumo Justificativa e objetivos: A cateterização venosa central da veia jugular interna é um procedimento invasivo feito frequentemente e associado a morbilidade significativa e até mesmo mortalidade. Os métodos guiados por ultrassonografia têm demonstrado uma melhoria do sucesso desse procedimento e são recomendados por várias sociedades científicas, incluindo a American Society of Anesthesiologists. O objetivo deste artigo é descrever uma abordagem inovadora de cateterização venosa central guiada por ultrassonografia no nível da veia jugular interna. Técnica: Os autores descrevem técnica ecoguiada inovadora de cateterização venosa central da veia jugular interna, baseada numa abordagem oblíqua - a abordagem Syringe-Free. Essa técnica permite uma progressão imediata do fio-guia ao longo do lúmen venoso e manter uma visualização ecográfica em tempo real e contínua. Conclusões: A técnica descrita acrescenta à técnica oblíqua tradicional a possibilidade de, com um único operador, conseguir uma punção venosa central com visualização ecográfica contínua e em tempo real associada à inserção do fio-guia sem necessidade de afastamento do transdutor de ultrassonografia do campo de punção.
Subject(s)
Humans , Catheterization, Central Venous/methods , Ultrasonography, Interventional , Jugular Veins/diagnostic imaging , Catheterization, Central Venous/instrumentation , Equipment DesignABSTRACT
Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.
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Aims and objectives: Landmark-guided internal jugular vein (IJV) cannulation is a basic procedure, which every anesthetist is expected to acquire. A successful first attempt is desirable as each attempt increases the risk of complications. The present study is an analysis of 976 IJV cannulations performed in adults undergoing cardiothoracic surgery. Materials and Methods: The IJV was cannulated with a triple lumen catheter using the anatomical landmarks. The following data were recorded: Patient demographics, age, sex, body mass index, diagnosis, operative procedure, operator (resident/consultant), site of cannulation (central approach, right IJV, left IJV, external jugular vein), number of attempts and duration of cannulation, length of insertion of the catheter, number of correct placements on X-ray and any complications. Results: The success rate of IJV cannulation was 100%. In 809 (82.9%) patients, cannulation was performed in the first attempt. Residents performed 792 cannulations and the consultants performed 184 cannulations. In 767 patients, the residents were successful in inserting the catheter and in 25 they failed after 5 attempts, hence, they were cannulated by the consultant. The time taken for insertion of the catheter was 6.89 ± 3.2 minutes. Carotid artery puncture was the most common complication, it occurred in 22 (2.3%) patients. Conclusion: IJV cannulation with landmark technique is highly successful with minimal complications in the adult patients undergoing cardiothoracic surgery. Basic training of cannulating the IJV by landmark technique should be imparted to all the traines as ultrasound may not be available in all locations.
Subject(s)
Adult , Aged , Cardiac Surgical Procedures/methods , Catheterization, Central Venous/methods , Child , Female , Humans , Jugular Veins/surgery , Jugular Veins/diagnostic imaging , Male , Ultrasonography, Interventional/methodsABSTRACT
Objective To investigate the application of the ultrasonic guidance-assisted neonatal internal jugular vein catheterization.Methods Sixty two newborns (including low birth weight infants) receving thoracic/abdominal operation or resection of malignant tumor on the body-surface were randomly assigned to ultrasound guidance (UG) group or surface mark landmark(S) group.Newborns in both groups were all punctured with 22G venous indwelling needles to place the external casing,followed by the steel wire guidance-assisted implantation of ARROW 4F dual chamber central venous catheter.Then we compared the rate of successful insertion attempt,rate of malpositioning,complications and average operation time between the two groups.Results The rate of successful insertion attempt was 96.8%(30/31) in the UG group,significantly higher than that in the S group (32.3%,10/31),there was significant difference between the two groups(χ2=28.182,P=0.000).Malpositioning happened in 2 cases in the UG group,but 25 cases in the S group.Rate of complications was higher in the S group compared to the UG group (64.5% vs 3.2%,χ2=25.99,P=0.000).Most importantly,the average operation time was (4.366±1.137)min in the UG group,significantly shorter than that of the S group [(13.70±5.34)min,t=5.463,P=0.028)].ConclusionUltrasound guidance-assisted catheterization for neonatal internal jugular vein is safe and feasible and can dramatically improve the success rate and prevent complications.
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Retropharyngeal hematoma is a rare, but a life-threatening complication when an internal jugular vein cannulation is performed in a patient with thrombocytopenia and coagulopathy. This report presents the case of a patient with acute airway obstruction that was caused by retropharyngeal hematoma. We discuss the diagnosis, airway management and treatment of this condition.