Ultrasound-guided central venous access for patients in the Intensive Care Unit in prone position: report of three cases

Abstract The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

Clinical study of internal jugular vein dilatation index in predicting septic shock volume responsiveness / 中华急诊医学杂志

Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.

Study on relationship between venous system and white matter hyperintensitiy in cerebral small vessel disease / 中国综合临床

White matter hyperintensity (WMH) is one of the major imaging markers of cerebral small vascular disease, which is prevalent in the elderly. At present, the pathogenesis of WMH is not clear, most of the previous studies focused on the arterial system, but the role of the venous system in WMH is attracting more and more attention. Small venous collagen hyperplasia, downstream intracranial venous dilatation and internal jugular venous reflux may be involved in the formation and development of white matter hyperintensity.

"Massive hemoptysis" and shock after fever and cough / 中国当代儿科杂志

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.

Comparison Of Anterior And Posterior Approach Of Percutaneous Catheterization Of Internal Jugular Vein Under Real Time Ultrasound Guidance In Critically Ill Patients: A Prospective Randomised Study

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.

Drainage of External Jugular Vein into an Unusually Wider Internal Jugular Vein: A Rare Case Report.

The superficial veins are of utmost importanceclinically for cannulation, which is required fordiagnostic purposes and intravenous therapy. One suchsuperficial vein in the neck region is the externaljugular vein. The other vein, deeper in this region, isthe internal jugular vein. The internal jugular vein iscommonly used for central venous catheterization.Anomaly in the course and termination of bothexternal and Internal Jugular Veins (IJV) are critical asthey serve as an important route/site to perform variousdiagnostic or therapeutic procedures. Present caseshows a rare variation of termination of the rightexternal jugular vein into an unusually wider IJV.Variation as described in the present case, if found,would ease the clinicians' task to approach a lessaccessible IJV. Ultrasound-guided venouscatheterization would serve as a guide to perform theprocedure with ease and also to be familiar with suchvariations existing in the venous channels

Determination of recovery rate of levofloxacin microdialysis probe by high-performance liquid chromatography / 第二军医大学学报

Objective To investigate the in vitro and in vivo relative recovery rates of levofloxacin from microdialysis probes. Methods High-performance liquid chromatography (HPLC) was established for determination of levofloxacin concentrations. Column was Kromasil C18 (150 mm×4.6 mm, 5 μm), the mobile phase consisted of acetonitrile and 10 mmol/L of potassium dihydrogen phosphate solution (15:85), with column temperature being 30 °C, detection wavelength being 294 nm, and injection volume being 10 μL. The relative recovery rates of vascular microdialysis probes in vitro were measured by dialysis and reverse dialysis. The effects of drug concentration and flow rate on probe deliveries were investigated. The in vivo recovery rates of the probe in the jugular vein and prostate were measured by reverse dialysis, and the stability of 12 h recovery rate in vivo was investigated. Results When the concentration of levofloxacin was 0.1-50.0 μg/mL, the linear relationship was good in the HPLC analysis (r = 0.998 7), and its specificity was good. The precision and accuracy of high-, medium-, low-concentration quality control samples, and lower limit of quantitation all met the analysis requirements. In the in vitro relative recovery experiments, there was no statistical difference between the recovery rate and reverse recovery rate of the vascular microdialysis probes (P>0.05). Drug concentrations did not affect in vitro recovery rate. The recovery rate decreased with the increase of flow rate. In vivo, the relative recovery rate of the probe was (48.46±1.94)% in the jugular vein and (13.23±1.44)% in the prostate. The relative recovery rates were stable during 12 h. Conclusion The established HPLC can be used for the determination of levofloxacin microdialysis probe. Reverse dialysis can be used to detect the relative recovery rate of levofloxacin microdialysis probe in vivo.

Clinical efficacy of trans-jugular transcatheter closure of atrial septal defect solely under echocardiography guidance in infants / 中国胸心血管外科临床杂志

@#Objective    To explore the key points, indications and safety of trans-jugular transcatheter closure of atrial septal defect (ASD) in infants. Methods    The clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed. There were 20 males and 33 females with the age of 1.2 (0.5-2.9) years, and body weight of 9.0 (6.8-10.6) kg. The ASD diameter was 9.8 (8.0-14.0) mm. Thirty-one patients were treated under the guidance of transesophageal ultrasound (TEE), and the other 22 patients under the guidance of transthoracic echocardiography (TTE). We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography, and the average occluder size was 13.5±4.5 mm. Results    All of the 53 patients were successfully occluded, and none of them changed to radiation-guided or transthoracic surgery. Postoperative hospital stay was 3.35±0.70 d. There was no complication such as peripheral vascular injury, occluder malposition or displacement, serious arrhythmia or pericardial effusion. The patients were followed up for 14.3±5.1 months without arrhythmia, residual shunt, occluder malposition or displacement or thrombus. Conclusion    Echocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment, not only overcomes the radiation risk of radiation guidance, but also maintains the advantages of minimal invasiveness and safety, providing a new treatment option for such patients.

Correção cirúrgica de fístula carotídeo-jugular traumática / Surgical repair of a traumatic carotid-jugular arteriovenous fistula

Resumo Traumatismos cervicais penetrantes podem ser potencialmente fatais. Em cerca de 25% dos casos, há lesão vascular associada, que pode evoluir para fístulas arteriovenosas. Os autores apresentam um caso de correção tardia, por cirurgia aberta, de uma fístula carotídeo-jugular e fazem uma breve revisão sobre o diagnóstico e opções de tratamento dessa condição.

Abstract Penetrating neck injuries can be life threatening. In about 25% of cases there are vascular injuries, which can progress to formation of arteriovenous fistulas. The authors present a case of delayed open surgery to repair a carotid-jugular fistula and briefly review the diagnosis and treatment options for this condition.

Proximal penholding method – A variant to enhance safety of ultrasoundguided central venous cannulation: A prospective pilot study

Aims: A significant incidence of Posterior Vessel Wall Puncture (PVWP) was reported during ultrasound guidance (USG) for internal jugular vein (IJV) catheterization. We studied a new technique of USGIJV cannulation to minimize or avoid PVWP, thereby decreasing overall complication rate, irrespective of the operators' experience level. Materials and Methods: After ethical approval, a prospective study was conducted on adult patients of either gender between 18–65 years of age, belonging to the American Society of Anesthesiologists Physical Status I–III, undergoing general anesthesia and requiring USG-guided IJV cannulation. After induction of general anesthesia and intubation, USG-guided IJV cannulation was done using technique of “proximal pen-holding method” in patients placed in supine position with neck rotated in 15° rotation to the opposite side. The primary outcome was defined as success rate of USG-guided IJV cannulation and incidence of PVWP. The secondary outcome was the incidences of complications such as arterial puncture, adjacent tissue damage, and performer's ease of the procedure (0–10 scale; 0 denoting no ease and extreme difficulty and 10 denoting extreme ease and no difficulty). Results: In 135 patients, right IJV puncture, guidewire, and central line insertion were achieved in single attempt without any PVWP by nine operators which included two anesthesia consultants and seven senior registrars. No complications were reported and ease of procedure were rated as median (interquartile range) of 10 (10). Conclusions: The “proximal pen-holding method” for real-time USG-IJV cannulation helped in avoiding PVWP with lesser complication rate and greater performer's ease.

Endovascular repair of subclavian artery injury secondary to internal jugular vein catheterization: case report / Correção endovascular de lesão de artéria subclávia secundária à cateterismo de veia jugular interna: relato de caso

Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.

Resumo Justificativa e objetivos A cateterização da veia jugular interna guiada por ultrassom é um procedimento comum e geralmente seguro em sala cirúrgica. No entanto, a punção inadvertida de uma artéria não compressível, como a artéria subclávia, embora rara, pode estar associada a sequelas e risco para vida, incluindo hemomediastino, hemotórax e pseudoaneurisma. Relato de caso Descrevemos um caso bem-sucedido da correção endovascular de lesão da artéria subclávia direita em uma paciente de 75 anos. A artéria subclávia foi lesionada após cateterização guiada por ultrassom da veia jugular interna direita sob anestesia geral para cirurgia ortopédica. Conclusão Sob anestesia geral, vários fatores, como a hipotensão, podem mascarar os sinais de lesão da artéria subclávia. Este relato de caso indica que os médicos devem estar cientes das complicações da cateterização venosa central e tomar medidas imediatas.

Morphology And Morphometric Study On Anatomical Variations Of Jugular Foramen In Adult Human Skulls

Background: Jugular foramen, a large irregular foramen at the base of the skull , lies at the posterior end of petrooccipital suture between jugular process of occipital bone and jugular fossa of petrous part of temporal bone;above and lateral to foramen magnum. Many important structures pass through this foramen. Among these areInferior Petrosal Sinus, presence of three cranial nerves 9, 10, and 11 and Internal Jugular vein.The increasinguse of modern diagnostic procedures and new surgical approaches has created a need for much more detailedanatomical studies and explanations.Materials and Methods: The study was conducted in Osteology lab of Anatomy Department,KarpagaVinayagaInstitute of Medical Sciences, Chinnakolambakkam,Madurntakam taluk,Tamilnadu (India). 66 jugular foraminaof 33 Adult human skulls have been examined for study.Results and Conclusion: The morphometric and morphological analysis of jugular foramen were done in 33skulls, and the results obtained are mentioned below. The Mean average width of foramen is 15.26mm and theRange is between 10mm and 21mm. The Mean average length of foramen is 10mm and the Range is between 6mmand 14mm.Regarding, the size of the foramina; the Right side is larger than the Left side. Incomplete Intrajugularprocess is the commonest observation observed (in 64 foramina).Regarding,Intra Jugular Process contributionfor foramen, it is mainly from Temporal bone. Separate foramen for IPS was found only in one foramen out of 66foramina observed.The height of dome of jugular fossa is more on the Right than on the Left side (in 60.6% ofskulls).The range of Height of the Dome is 6.41mm to 18.46mm and the Mean average is 12.11mm.

Mid-term outcomes following valved bovine jugular vein conduit versus autologous pericardium conduit for right ventricular outflow tract reconstruction / 第二军医大学学报

Objective To compare the mid-term outcomes of valved bovine jugular vein conduit and autologous pericardium conduit in reconstruction of right ventricular outflow tract. Methods Eighteen congenital heart disease patients were implanted with external conduits (included 11 valved bovine jugular vein conduits and 7 autologous pericardium conduits) for right ventricular outflow tract reconstruction between May 2013 and Jul. 2016. There were 11 males and 7 females at age of 2-16 (5.22±4.12) years. Preoperative clinical diagnoses included pulmonary artery atresia with ventricular septal defect (n＝7), double outlet of right ventricle with pulmonary stenosis (n＝4), persistent truncus arteriosus (n＝3), persistent truncus arteriosus with absence of right pulmonary artery (n＝1), corrected transposition of great arteries with pulmonary stenosis (n＝1), and transposition of great arteries with pulmonary stenosis (n＝2). The perioperative status was recorded. The cardiac ultrasound and computed tomography angiography (CTA) were used to evaluate the efficacy during 4-56 months of follow-up. Results There were no perioperative deaths in the bovine jugular vein conduit group, and 2 deaths in the autologous pericardium conduit group. One died of pulmonary hypertension crisis and the other died of low cardiac output syndrome. The ratio of right ventricular pressure to radial arterial pressure, duration of mechanical ventilation and intensive care unit (ICU) stay after surgery were significantly lower in the bovine jugular vein conduit group than those in the autologous pericardium conduit group (all P0.05). There were no significant differences in extracorporeal circulation time, aortic cross-clamping time, transvalvular gradient in right ventricular outflow tract, blood consumption or total hospitalization costs between the two groups (all P0.05). During follow-up, there were no deaths in the two groups, no reoperations in the bovine jugular vein conduit group, and 1 case received reoperation 2 years after surgery due to severe right ventricular dysfunction in the autologous pericardium conduit group. In the bovine jugular vein conduit group, the transvalvular gradients in right ventricular outflow tract at the last follow-up and before discharge were (22.91±7.31) mmHg (1 mmHg＝0.133 kPa) and (20.45±6.70) mmHg, respectively, and the difference was not significant (P0.05). In the autologous pericardium conduit group, the transvalvular gradient in right ventricular outflow tract was (29.20±18.09) mmHg at the last follow-up and (16.14±4.02) mmHg before discharge, and the difference was significant (P0.05). At the last follow-up after surgery, there were 8 cases of mild reflux and 3 cases of moderate reflux in the bovine jugular vein conduit group, and 1 case of mild reflux, 2 cases of moderate reflux and 2 cases of severe reflux in the autologous pericardium conduit group, and the difference between the two groups was significant (P0.05). Postoperative ultrasonography showed the thickened valve leaflets with good valve movement in the bovine jugular vein conduit. No calcification, thrombosis and infective endocarditis were found in the two groups. Postoperative cardiac CTA found that there was aneurysmal dilatation in 1 middle segment and 1 proximal anastomotic stoma of the bovine jugular vein conduit group, and no dilatation in the autologous pericardium conduit group. Conclusion Domestic valved bovine jugular vein conduit is suitable for right ventricular outflow tract reconstruction in patients with complex congenital heart malformations. Mid-term follow-up shows that bovine jugular vein conduit has good anti-reflux performance and no severe obstruction or calcification. It is obviously superior to autologous pericardium conduit. However, some bovine jugular vein conduits have aneurysmal dilatation in mid-term follow-up, which needs to be further improved.

Thyroid tumor complicated with tumor thrombus in internal jugular vein: An analysis of 2 cases and literatures review / 中国实用外科杂志

OBJECTIVE: To investigate the clinical features,diagnosis and treatment of thyroid tumor complicated with tumor thrombus in internal jugular vein. METHODS: Case reports of thyroid tumor complicated with tumor thrombus in internal jugular vein published in domestic journals since January 2000 were retrieved. The clinical features and treatment procedures were analyzed combining with the data of 2 patients admitted to the Department of Vascular and Thyroid Surgery of Guizhou Provincial People's Hospital. RESULTS: A total of 10 reports were retrieved,including 23 patients.Of the 25 patients,14 were males and 11 were females,aged 44—84(62.9±9.8)years. The largest diameter of thyroid tumor was 2.8—8.0 cm.The length of tumor thrombus ranged from 1 cm to 30 cm. Among the 19 cases,14 were derived from intravascular spreading tumor thrombus,and 5 were from direct invasive tumor thrombus.There were 4 cases of papillary carcinoma,6 cases of follicular carcinoma,5 cases of poorly differentiated carcinoma,8 cases of undifferentiated carcinoma,1 case of myogenic sarcoma and 1 case of sclerosing epithelioid fibrosarcoma. Of the 13 cases,9 underwent internal jugular vein resection and 4 underwent thrombectomy. CONCLUSION: Thyroid tumors complicated with tumor thrombus in internal jugular vein are mostly tumors with strong vascular invasion ability.The long-term prognosis of the patients is very poor. Surgical treatment should be actively taken to remove the tumor thrombus and improve the prognosis of the patients.

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients / 中华肾脏病杂志

Objective@#To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients.@*Methods@#A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy.@*Results@#Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P<0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age<65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020).@*Conclusions@#There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.

Thrombosis after establishing internal jugular vein channel in one burn patient / 中华烧伤杂志

On September 7th, 2017, one female patient, aged 48 years with deep partial-thickness flame burn on face, upper limbs, trunk, and lower limbs of 40% total body surface area was admitted to the First People′s Hospital of Foshan City. After admission, active fluid replacement, anti-infection, nutritional support, and other treatments were performed. After debridement and skin grafting for 3 times and blood transfusion for 2 times, the patient recovered well. On the 20th day post admission, sudden heartbeat and respiratory arrest happened, and the patient died after ineffective rescue. Autopsy showed that thrombus formed in right internal jugular vein and deep veins of lower extremities, and vascular lumina of the bilateral pulmonary artery. The direct cause of death was acute pulmonary thromboembolism, but whether the embolus originated from deep vein of lower extremity or right internal jugular vein was not clear. This case suggests that clinician should not only pay attention to the prevention of deep venous thrombosis of lower extremities of burn patients, but also the possibility of internal jugular vein thrombosis, especially for patients with internal jugular vein access.

Bilateral internal jugular vein thrombosis in a patient with severe burn / 中华烧伤杂志

A 33 years old male patient who suffered from a flame burn of 88% total body surface area was admitted to our hospital on November 28th, 2016. During his hospitalization, we repeatedly performed central vein catheterization in internal jugular veins, subclavian veins, or femoral veins for fluid transfusion. We incidentally found bilateral internal jugular vein thrombosis by performing a point-of-care ultrasound examination before catheterizing sometime. We treated the patient by avoiding catheterization in the affected internal jugular veins, anticoagulating with low molecular weight heparin, closing the wounds with skin autografting, and guiding the patient to practice functional exercise. The thrombus disappeared in the end. The patient was cured and discharged 3 months post burn.

Transjugular closure of atrial septal defect under transesophageal echocardiography guidance in infants:A report of 13 cases / 中国实用儿科杂志

OBJECTIVE: To explore the availability of transcatheter closure of atrial septal defect(ASD)in infants guided by transesophageal echocardiography(TEE). METHODS: The clinical data of 13 infants(under one year old)with ASD who underwent transcatheter closure via right jugular vein through adjustable curved sheath under guidance of TEE from June 2015 to March 2018 in Qingdao Women and Children's Hospital were analyzed retrospectively. The operation effect,time and complications were evaluated. RESULTS: All 13 infants were successfully occluded. TEE can accurately guide the establishment of the delivery track. The operation time was(27.2±15.1)minutes. All patients had satisfactory occluder shape and fixed position,without such complications as arrhythmia,hemolysis,embolism,infection,pneumothorax,hemothorax or vessel injury.CONCLUSION: TEE-guided transjugular closure of ASD is a feasible method,which can avoid surgical risks and vessel complications in young and low-bodyweight infants;Meanwhile,the potential radiation damage can be avoided.

Hemangioma de veia jugular externa: relato de caso / External jugular vein hemangioma: case report

Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo

Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients / 中华肾脏病杂志

Objective To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23％, 36.52％, 41.11％ and 3.14％respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P﹤0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1％. The right internal jugular vein stenosis rate was 66.4％and 44.1％in the age﹤65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0％and 32.8％(P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95％ CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.