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1.
Autops. Case Rep ; 11: e2020188, 2021. graf
Article in English | LILACS | ID: biblio-1142403

ABSTRACT

Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.


Subject(s)
Humans , Female , Middle Aged , Venous Thrombosis/pathology , Jugular Veins/pathology , Aneurysm/pathology
2.
Rev. bras. cir. cardiovasc ; 35(4): 420-426, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137301

ABSTRACT

Abstract Objective: To compare peripheral and central cannulation techniques in cardiac reoperation. Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cardiac Surgical Procedures , Stroke Volume , Catheterization , Retrospective Studies , Ventricular Function, Left , Treatment Outcome
3.
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 44-48, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1089370

ABSTRACT

Abstract Introduction The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy. Objective To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space. Methods A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed. Results The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40 mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers. Conclusion Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.


Resumo Introdução A complexidade anatômica do forame jugular torna a realização de procedimentos cirúrgicos nessa região delicada e difícil. Devido aos avanços obtidos nas técnicas cirúrgicas, as abordagens do forame jugular têm sido feitas com maior frequência, o que requer uma melhoria correspondente no conhecimento de sua anatomia. Objetivo Estudar a anatomia do forame jugular, da veia jugular interna e dos nervos glossofaríngeo, vago e acessório, assim como as relações anatômicas entre estas estruturas na região do forame jugular e no espaço parafaríngeo. Método Foram examinados 60 lados de 30 cadáveres frescos algumas horas após a morte. Os diâmetros e suas relações anatômicas foram analisados. Resultados Os diâmetros do forame jugular e da veia jugular interna foram maiores no lado direito na maioria dos espécimes estudados. O seio petroso inferior terminava na veia jugular interna até 40 mm abaixo do forame jugular, em 5% dos casos. O nervo glossofaríngeo exibiu uma relação íntima anatômica com o músculo estiloglosso após a sua saída do crânio e o nervo vago exibiu uma relação semelhante com o nervo hipoglosso. O nervo acessório passou em torno da veia jugular interna via sua parede anterior em 71,7% dos cadáveres. Conclusão Foram encontradas variações anatômicas nas dimensões do forame jugular e da veia jugular interna, que apresentaram tamanhos maiores à direita na maioria dos espécimes estudados; variações também ocorreram na trajetória e nas relações anatômicas dos nervos. O seio petroso pode se unir à veia jugular interna abaixo do forame.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anatomic Variation/physiology , Jugular Foramina/anatomy & histology , Neck/anatomy & histology , Vagus Nerve/anatomy & histology , Dissection , Glossopharyngeal Nerve/anatomy & histology , Accessory Nerve/anatomy & histology , Jugular Veins/anatomy & histology
4.
J. bras. econ. saúde (Impr.) ; 11(2): 112-118, Agosto/2019.
Article in Portuguese | LILACS, ECOS | ID: biblio-1021040

ABSTRACT

Objetivo: Determinar a factibilidade econômica da técnica de cateterismo central em veia jugular interna guiada pelo ultrassom comparado à técnica-padrão, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Métodos: Análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária. Os custos diretos dos materiais e procedimentos foram estimados utilizando bancos de registros de compras nacionais. Os desfechos foram a ocorrência ou não da punção arterial acidental grave (principal complicação associada ao sítio de punção). Também foram conduzidas análises de sensibilidade determinística e probabilística, bem como curva de aceitabilidade. Resultados: A intervenção onerou o modelo em R$ 53,81. A razão de custo-efetividade incremental calculada foi de R$ 17.936,66 por complicação grave evitada e a curva de aceitabilidade evidenciou que a técnica é custo-efetiva sob uma intenção de pagar de R$ 18.125,00. Na análise de sensibilidade probabilística, 63,6% das simulações mostraram-se custo-efetivas. Conclusão: A intervenção é custo-efetiva, contribuindo para a redução das complicações graves, e o resultado pode proporcionar segurança para tomadas de decisões quanto à padronização do uso da ultrassonografia como orientador do procedimento.


Objective: To determine the economic feasibility of the central catheterization technique in the internal jugular vein guided by the ultrasound compared to the standard technique, under the perspective of the Brazilian Unified Health System. Methods: Cost-effectiveness analysis using decision tree model under a population of adult patients in a tertiary unit scenario. The direct costs of the materials and procedures were estimated using banks of national procurement records. The outcomes were the occurrence or not of severe accidental arterial puncture (the main complication associated with the puncture site). Analyzes of deterministic and probabilistic sensitivity were also conducted, as well as acceptability curve. Results: The intervention cost the model in R$ 53.81. The calculated incremental cost-effectiveness ratio was R$ 17,936.66 due to a serious complication avoided and the acceptability curve showed that the technique is cost-effective under an intention to pay R$ 18,125.00. In the probabilistic sensitivity analysis, 63.6% of the simulations were cost-effective. Conclusion: The intervention is cost-effective, contributing to the reduction of severe complications and the result can provide security for decision making regarding the standardization of the use of ultrasonography as a guideline of the procedure


Subject(s)
Humans , Catheterization, Central Venous , Ultrasonography, Interventional , Cost-Effectiveness Evaluation , Jugular Veins
5.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 592-595, May 2019. graf
Article in English | LILACS | ID: biblio-1012953

ABSTRACT

SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.


RESUMO A hipertensão pode cursar com disfunção diastólica de ventrículo esquerdo (VE) e a consequência disso pode ser sintomas e sinais de insuficiência cárdica (IC). O refluxo hepatojugular (RHJ), descrito como sinal de regurgitação da valva tricúspide, pode refletir alterações estruturais e funcionais do VE no paciente hipertenso. O sinal pode estar presente na vigência de IC. Caso: homem, 49 anos compressão arterial não controlada. Ao exame físico apresentou turgência jugular, RHJ e pressão arterial elevada. Os exames complementares mostraram sinais de sobrecarga atrial e de ventrículo esquerdo no eletrocardiograma, e no ecocardiograma foi evidenciado aumento do volume do átrio esquerdo, hipertrofia concêntrica do VE e sinais de disfunção diastólica grau I. DISCUSSÃO: RHJ presente correlaciona-se com a pressão da artéria pulmonar e provavelmente reflete o aumento do volume sanguíneo central.


Subject(s)
Humans , Male , Stroke Volume/physiology , Tricuspid Valve Insufficiency/physiopathology , Ventricular Dysfunction, Left/physiopathology , Heart Failure/physiopathology , Jugular Veins/physiopathology , Tricuspid Valve Insufficiency , Echocardiography , Electrocardiography , Heart Failure/pathology , Hypertension/physiopathology , Jugular Veins/pathology , Middle Aged
6.
Article | IMSEAR | ID: sea-183681

ABSTRACT

Osteosarcoma (OS) is an uncommon primary malignant brain tumor. The incidence of osteosarcoma of the skull is low with an estimated 3.4 cases per million reported per year. We report a case of OS of the skull in an 18-year-old female patient. She had complained of swelling on the left side of the head accompanied with frequent headache and diminished vision in the left eye. An PET-CT of the skull revealed a large 93x90 mm lesion in the left parietal-occipital region. Osteoblastic osteogenic sarcoma of the skull was confirmed histopathologically. The patient received six cycles of Adriamycin and cisplatin; is under close observation and currently doing well. It is empirical to report case reports, specifically unusual cases like OS of the skull. Case reports not only help disseminate knowledge but also help streamline diagnostic and treatment approaches for unusual cases.

7.
Article in Chinese | WPRIM | ID: wpr-752735

ABSTRACT

Objective To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC). Methods Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups. Results The rate of jugular vein malposition in the first try of catheterization was 19.1% (130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ2=3.917, P=0.047 8). Conclusion Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.

8.
Article in English | WPRIM | ID: wpr-763999

ABSTRACT

Jugular bulb diverticulum is an irregular extension of the jugular bulb into the temporal bone that may be symptomatic or asymptomatic. The jugular bulb has rarely been reported to extend into the occipital condyle; such extension is termed a condylar jugular diverticulum and is characterized as a defect in the occipital condyle contiguous with the jugular bulb. This report details 3 cases of condylar jugular diverticulum. Extension of the jugular bulb into the ipsilateral occipital condyle was noted as an incidental finding on cone-beam computed tomographic (CBCT) images of 3 patients. All 3 patients were asymptomatic, and this finding was unrelated to the initial area of interest. CBCT use is becoming ubiquitous in dentistry, as it allows 3-dimensional evaluation, unlike conventional radiography. Proper interpretation of the entire CBCT is essential, and recognition of the indicators of condylar jugular diverticulum may prevent misdiagnosis of this rare entity.


Subject(s)
Cone-Beam Computed Tomography , Dentistry , Diagnostic Errors , Diverticulum , Growth and Development , Humans , Incidental Findings , Jugular Veins , Radiography , Temporal Bone
9.
Article in Chinese | WPRIM | ID: wpr-803354

ABSTRACT

Objective@#To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC).@*Methods@#Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups.@*Results@#The rate of jugular vein malposition in the first try of catheterization was 19.1%(130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ2=3.917, P=0.047 8).@*Conclusion@#Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.

10.
Chinese Journal of Anesthesiology ; (12): 1135-1138, 2019.
Article in Chinese | WPRIM | ID: wpr-798081

ABSTRACT

Objective@#To evaluate the accuracy of trans-xiphoid inferior vena cava diameter variation (v-IVCTX), trans-liver inferior vena cava diameter variation (v-IVCTL), internal jugular vein diameter variation (v-IJV) and femoral vein diameter variation (v-FV) in predicting the fluid responsiveness in the patients with septic shock complicated with myocardial injury.@*Methods@#Fifty patients with septic shock complicated with myocardial depression admitted to intensive care unit of our hospital, aged ≥18 yr, were selected.The hemodynamics was monitored by PiCCO.Cardiac output (CO) and stroke volume were measured, and v-IVCTX, v-IVCTL, v-IJV and v-FV were measured by ultrasound and then calculated.Fluid replacement test was performed after meeting the standard of fluid resuscitation, and positive fluid responsiveness was defined as increase in CO after volume expansion>10%.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group.The receiver operating characteristic curve was drawn to evaluate the accuracy of the respiratory variation of each vein diameter in predicting fluid responsiveness.@*Results@#Compared with negative fluid responsiveness group, v-IVCTX, v-IVCTL and v-IJV were significantly increased (P<0.05), and no significant change was found in v-FV, CO or stroke volume in positive fluid responsiveness group (P>0.05). The cutoff value of v-IVCTX, v-IVCTL and v-IJV in predicting fluid responsiveness was 16.5%, 14.5% and 12%, respectively, the sensitivity was 80%, 76% and 84%, respectively, and the specificity was 72%, 64% and 44%, respectively.The area under the curve (95% confidence interval) of v-IVCTX, v-IVCTL and v-IJV was 0.777 (0.642-0.911), 0.741 (0.605-0.876), and 0.694 (0.549-0.838), respectively.@*Conclusion@#v-IVCTX and v-IVCTL both can predict the fluid responsiveness in the patients with septic shock complicated with myocardial injury.

11.
Article in Chinese | WPRIM | ID: wpr-861263

ABSTRACT

Objective: To compare the efficacy and safety of ultrasound-guided stellate ganglion block (UGSGB) through anterior scalenus muscle (ASM) and through internal jugular vein (IJV). Methods: Totally 144 patients with cervicogenic headache were distributed into 2 groups randomly. USSGB was performed through ASM (ASM group, n=72) or through IJV (IJV group, n=72), respectively. The ratio of successful blocks, the appearing time of Honer syndrome and the ratio of adverse reaction were compared between two groups. Results: The successful block ratio was 97.22% (70/72) of ASM group and 98.61%(71/72) of IJV group, while Honer syndrome appearing times was (2.18±0.96)min and (1.96±0.87)min after operation, respectively. There was no significant difference between 2 groups (both P>0.05). The adverse reaction ratio was 19.44%(14/72) of SCM group and 4.17%(3/72) of IJV group (P=0.01). Conclusion: USSGB through ASM approach and USSGB through IJV approach are both safe and efficient. IJV approach has less adverse reaction than SCM approach.

12.
Chinese Journal of Anesthesiology ; (12): 1135-1138, 2019.
Article in Chinese | WPRIM | ID: wpr-824672

ABSTRACT

Objective To evaluate the accuracy of trans-xiphoid inferior vena cava diameter variation (v-IVCTX),trans-liver inferior vena cava diameter variation (v-IVCTL),internal jugular vein diameter variation (v-IJV) and femoral vein diameter variation (v-FV) in predicting the fluid responsiveness in the patients with septic shock complicated with myocardial injury.Methods Fifty patients with septic shock complicated with myocardial depression admitted to intensive care unit of our hospital,aged ≥ 18 yr,were selected.The hemodynamics was monitored by PiCCO.Cardiac output (CO) and stroke volume were measured,and v-IVCTx,v-IVCTL,v-IJV and v-FV were measured by ultrasound and then calculated.Fluid replacement test was performed after meeting the standard of fluid resuscitation,and positive fluid responsiveness was defined as increase in CO after volume expansion> 10%.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group.The receiver operating characteristic curve was drawn to evaluate the accuracy of the respiratory variation of each vein diameter in predicting fluid responsiveness.Results Compared with negative fluid responsiveness group,v-IVCTx,v-IVCTL and v-IJV were significantly increased (P<0.05),and no significant change was found in v-FV,CO or stroke volume in positive fluid responsiveness group (P>0.05).The cutoff value of v-IVCTx,v-IVCTLand v-IJV in predicting fluid responsiveness was 16.5%,14.5% and 12%,respectively,the sensitivity was 80%,76% and 84%,respectively,and the specificity was 72%,64% and 44%,respectively.The area under the curve (95% confidence interval) of v-IVCTx,v-IVCTL and v-IJV was 0.777 (0.642-0.911),0.741 (0.605-0.876),and 0.694 (0.549-0.838),respectively.Conclusion v-IVCTx and v-IVCTL both can predict the fluid responsiveness in the patients with septic shock complicated with myocardial injury.

13.
Rev. Soc. Bras. Clín. Méd ; 16(1): 37-40, 20180000. ilus, tab
Article in Portuguese | LILACS | ID: biblio-884992

ABSTRACT

Descrita pela primeira vez em 1900 por Coumont e Cade, a tromboflebite séptica da veia jugular interna (síndrome de Lemierre) é uma condição rara. Acomete indivíduos jovens e possui elevada morbimortalidade. Relatamos o caso de uma paciente atendida inicialmente como portadora de amigdalite bacteriana e que retornou com piora do quadro, associado à trombose da veia jugular interna, evoluindo, na internação, com embolia séptica pulmonar. Além de relatar o caso, fazemos breve revisão da literatura e chamamos a atenção sobre este importante assunto.(AU)


First described in 1900 by Coumont and Cade, septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome) is relatively rare. It affects young patients and has high morbidity and mortality. We describe the case of a woman first diagnosed with a bacterial tonsillitis, who returned to the hospital with worsening of the condition, associated with internal jugular vein thrombophlebitis, that developed to pulmonary embolism during her hospitalization. We reported the case, and made a brief review of the literature, highlighting the details of this important condition.(AU)


Subject(s)
Humans , Female , Adult , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Jugular Veins/pathology , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapy , Pulmonary Embolism
14.
Article | IMSEAR | ID: sea-183690

ABSTRACT

External jugular vein is the superficial vein of the neck and is prone to variations. Multiple internal jugular veins are incidental findings that present as a duplication or fenestration. We encountered a unilateral fenestrated internal jugular vein and a bilateral variation in the course of external jugular vein, during a cadaveric dissection. The external jugular vein, after its formation, crossed the sternocleidomastoid muscle and pierced the investing cervical fascia of the posterior triangle. It traversed deep to the inferior belly of omohyoid muscle to enter the subclavian triangle and terminated by draining into the subclavian vein on the left side, and at the angle between the internal jugular vein and the subclavian vein on the right side. The fenestrated internal jugular vein on the left side divided into a small medial and large lateral division which reunited at the level of the tendon of omohyoid muscle and drained into the subclavian vein. Only the medial division of the internal jugular vein received tributaries in the neck. Awareness of the multiple variations of the jugular veins would be valuable during surgical approaches to the neck. Present report aims to be useful for vascular surgeons, radiologists, and intensivists as well.

15.
Article in English | WPRIM | ID: wpr-719236

ABSTRACT

OBJECTIVE: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). METHODS: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured. RESULTS: Alpha (α) angles tended to increase for upper cervical levels (53.3° in C6-7, 65.2° in C5-6, 75.3° in C4-5, 82.3° in C3-4). Beta (β) angles for conventional TFESI showed a constant value of 45° to 47° (47.5° in C6-7, 47.4° in C5-6, 45.7° in C4-5, 45.0° in C3-4). Gamma (γ) angles increased at higher cervical levels as did α angles (25.2° in C6-7, 33.6° in C5-6, 43.0° in C4-5, 56.2° in C3-4). CONCLUSION: The risk of causing injury by penetrating major vessels in the carotid sheath tends to increase at upper cervical levels. Therefore, prior to cervical TFESI, measuring the angle is necessary to avoid carotid vessels in the axial section of CT or MRI, thus contributing to a safer procedure.


Subject(s)
Carotid Arteries , Fluoroscopy , Humans , Jugular Veins , Magnetic Resonance Imaging , Needles , Spine , Vascular System Injuries
16.
Article in Korean | WPRIM | ID: wpr-719091

ABSTRACT

OBJECTIVE: This study examined the incidence and amount of air inflow during central venous catheter (CVC) insertion. METHODS: This study was an experimental study aimed at designing an apparatus to implement blood vessel and blood flow in the human body. A 1.5-m long core tube with a Teflon tube, suction rubber tube, and polyvinyl chloride tube were made. This core tube was assumed to be the blood vessel of the human body. Blood was replaced with a saline solution. The saline solution was placed higher than the core tube and flowed into the inside of the tube by gravity. The CVC was injected 15-cm deep into the core tube. The air was collected through a 3-way valve into the upper tube. The experiments were carried out by differentiating the pressure in the tube, CVC insertion step, and diameter of the end of the catheter. The experiment was repeated 10 times under the same conditions. RESULTS: The amount of air decreased with increasing pressure applied to the tube. Air was not generated when the syringe needle was injected, and the amount of air increased with increasing size of the distal end catheter. CONCLUSION: To minimize the possibility of air embolism, it is necessary to close the distal end catheter at the earliest point as soon as possible.


Subject(s)
Blood Vessels , Catheters , Central Venous Catheters , Embolism, Air , Gravitation , Human Body , Incidence , Jugular Veins , Needles , Polytetrafluoroethylene , Polyvinyl Chloride , Rubber , Sodium Chloride , Suction , Syringes
17.
Article in Chinese | WPRIM | ID: wpr-709771

ABSTRACT

Objective To evaluate the anatomical factor and risk assessment of right internal jugular vein (IJV) puncture-related damage to the vertebral artery (VA) at different neck planes in pediatric patients.Methods Two hundred and ten pediatric patients of both sexes,aged 6 months-10 yr,with body mass index less than 28 kg/m2,undergoing elective surgery,were enrolled in this study.At the cricoid cartilage plane,supraclavicular area plane and intermediate plane,the right IJVs and VAs were examined using ultrasound.The VA position relative to the IJV,diameters of IJVs and VAs (the diameter ratio of VAs to IJVs was calculated),extent of overlap between IJVs and VAs,and horizontal and vertical distance from VAs to IJVs were recorded,and the risk coefficient of accidental VA puncture was calculated.Results Ninety-seven percent of VAs lay deep and lateral to right IJVs.There was no significant difference in each parameter of VA position relative to IJVs between the three planes (P>0.05).The diameter ratio of VAs to IJVs was decreased with the decreasing neck plane,the horizontal and vertical distance from VAs to IJVs was significantly shortened,the overlapping rate between VAs and IJVs was increased,and the risk coefficient of accidental VA puncture was increased (P<0.05 or 0.01).The vertical distance from VAs to IJVs was not correlated with age,body weight or height (P>0.05).The risk coefficient of VA damage was not correlated with age,body weight or height at the cricoid cartilage plane and intermediate plane (P > 0.05).The risk coefficient of VA damage was positively correlated with the weight of pediatric patients at the supraclavicular area plane (P<0.05,r=0.215).Conclusion Right VAs come nearer IJVs with the decreasing neck plane;the risk of VA damage increases gradually with the lowering of neck planes in pediatric patients.

18.
Article in Chinese | WPRIM | ID: wpr-709726

ABSTRACT

Objective To compare internal jugular vein diameter and brachial artery peak velocity variation (VVp) in predicting fluid responsiveness.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,of New York Heart Association I,aged 18-64 yr,scheduled for elective gastrointestinal surgery under general anesthesia,were included in this study.Six percent hydroxyethyl starch 130/0.47 ml/kg was infused at a rate of 0.4 ml · kg-1 · min-1 after induction of anesthesia.The patients with the changing rate of stroke volume variation (ASVV) more than or equal to 15% were included in responsiveness group and patients with ASVV less than 15% were included in non-responsiveness group after volume expansion.Immediately after volume expansion and at 3 min after volume expansion,mean arterial pressure,central venous pressure and heart rate were recorded,the maximum diameter of the internal jugular vein at the end of inspiration (IJVmax) and the minimum diameter of the internal jugular vein at end of expiration (IJVmin) and brachial artery peak velocity were measured using an ultrasonic instrument,and the variation of internal jugular vein respiration (VIJV) and VVp were calculated.The receiver operating characteristic curve was used to evaluate the accuracy of IJV IJVmin,VIJV and VVp in predicting fluid responsiveness.Results There were 31 patients in responsiveness group and 29 patients in non-responsiveness group.Compared with non-responsiveness group,mean arterial pressure,central venous pressure,IJVmax and IJVmin were significantly decreased and heart rate,VIJV and VVp were increased immediately after volume expansion in responsiveness group (P<0.05).The areas under receiver operating characteristic curve (AUC) of IJV IJVmin,VIJV and VVp were 0.753,0.948,0.837 and 0.832,respectively.AUC IJVmax,AUCVIJV and AUCVVp were significantly decreased when compared with AUC IJVmin (P<0.05).Conclusion The accuracy of IJVmax is higher than that of VVp in predicting intraoperative fluid responsiveness in the patients.

19.
Rev. bras. anestesiol ; 67(3): 314-317, Mar.-June 2017. graf
Article in English | LILACS | ID: biblio-843400

ABSTRACT

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 Design
20.
Rev. bras. cir. cardiovasc ; 32(2): 111-117, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843472

ABSTRACT

Abstract INTRODUCTION: The biggest challenge faced in minimally invasive pediatric cardiac surgery is cannulation for cardiopulmonary bypass. Our technique and experience of cervical cannulation in infants and small children for repair of congenital cardiac defects is reported in this study. METHODS: From January 2013 to June 2015, 37 children (22 males) with mean age of 17.97±8.63 months and weight of 8.06±1.59 kg were operated on for congenital cardiac defects through right lateral thoracotomy. The most common diagnosis was ventricular septal defect (18 patients). In all patients, right common carotid artery, right internal jugular vein and inferior vena cava were cannulated for institution of cardiopulmonary bypass and aorta was cross clamped through right 2nd intercostal space. RESULTS: There were no deaths or any major complications related to cervical cannulation. Common carotid artery cannulation provided adequate arterial inflow while internal jugular vein with inferior vena cava provided adequate venous return in all patients. No patient required conversion to sternotomy or developed vascular, neurological or wound related complications. Three patients had residual lesions (small leak across ventricular septal defect patch-2, Grade II left atrio-ventricular valve regurgitation-1) and one patient had mild left ventricular dysfunction. At discharge, both common carotid artery and internal jugular vein were patent on color Doppler ultrasonography in all patients. In a mean follow-up period of 11.4±2.85 months, all patients were doing well. No patient had any wound related, neurological or vascular complication. No patient had residual leak across ventricular septal defect patch. CONCLUSION: Cervical cannulation of common carotid artery and internal jugular vein is a safe, reliable, efficient and quick method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Vena Cava, Inferior , Catheterization/methods , Carotid Artery, Common , Heart Defects, Congenital/surgery , Jugular Veins , Postoperative Period , Thoracotomy/methods , Catheterization/instrumentation , Echocardiography , Cardiopulmonary Bypass/methods , Retrospective Studies , Heart Defects, Congenital/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Heart Septal Defects, Ventricular/diagnostic imaging
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