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

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.

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.

Cerebral Venous Infarction Due to Brachial Artery-Jugular Vein Jump Graft in a Hemodialysis Patient

Hemodialysis patients rarely experience neurologic symptoms related to their vascular accesses. However, occlusion of venous drainage induces extreme venous hypertension and in rare cases cause intracranial venous congestion. We report a patient with cerebral venous infarction resulting from reflux flow into the cranium induced by an arteriovenous jump graft to the internal jugular vein. Clinicians should take into account the possibility of neurologic deficit related to intracranial venous hypertension in hemodialysis patients.

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.

Cut-down method for perm catheter insertion in patients with completely occluded internal jugular vein

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.

A Case of Lemierre's Syndrome, Misdiagnosed as a Simple Deep Neck Infection on Initial Ultrasonography Followed by an Abscess Aspiration Trial / 대한두경부종양학회지

Lemierre's syndrome is rare disease characterized by anaerobic sepsis, internal jugular vein thrombosis, septic emboli that resulted from head and neck infection. Lemierre's syndrome has significant morbidity, so immediate, accurate diagnosis and treatment is needed. It is necessary to perform contrast-enhanced computed tomography (CT) for diagnosis. Systemic antibiotics is recommended, and surgical interventions, anticoagulation may beis considered for treatment. We report misdiagnosed case as a simple deep neck infection on initial ultrasonography with simultaneous abscess aspiration but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.We report a case of a 45-year-old patient, who was diagnosed with a simple deep neck infection and treated with simultaneous abscess aspiration, but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.

Comparison of transverse short-axis classic and oblique long-axis "Syringe-Free" approaches for internal jugular venous catheterization under ultrasound guidance / Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom

Abstract Background and objectives: There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in-plane or out of plane needle approach may be used for catheterization. Transverse short-axis classic approach is the most popular performed approach in literature. "Syringe-Free" is a new described technique that is performed with oblique long-axis approach. We aimed to compare performance of these two approaches. Methods: This study was conducted as a prospective and randomized study. 80 patients were included the study and allocated into two groups that were named Group C (transverse short-axis classic approach) and Group SF (oblique long-axis syringe-free approach) by a computer-generated randomization. The primary outcome was mean time that guidewire is seen in the Internal jugular vein (performing time). The secondary outcomes were to compare number of needle pass, number of skin puncture and complications between two groups. Results: Demographic and hemodynamic data were not significantly different. The mean performing time was 54.9 ± 19.1 s in Group C and 43.9 ± 15.8 s in Group SF. Significant differences were found between the groups (p = 0.006). Mean number of needle pass was 3.2 (± 2.1) in Group C and 2.1 (± 1.6) in Group SF. There were statistically significant differences between two groups (p = 0.002). The number of skin puncture was 1.6 (± 0.8) and 1.2 (± 0.5) in Group C and SF, respectively (p = 0.027). Conclusion: "Syringe-Free" technique has lower performing time, number of needle pass and skin puncture. Also, it allows to follow progress of guide-wire under continuous ultrasound visualization and the procedure does not need assistance during catheter insertion. Namely, "Syringe-Free" is effective, safe and fast technique that may be used to place internal jugular venous catheter.

Resumo Justificativa e objetivos: Há diferentes posições do probe do ultrasom que são utilizadas para a colocação de cateter em veia jugular interna. Além disso, a aproximação da agulha no plano ou fora do plano pode ser usada para o cateterismo. A abordagem transversal clássica no eixo curto é a abordagem mais popular na literatura. Sem seringa é uma nova técnica descrita, realizada com a abordagem oblíqua no eixo longo. Nosso objetivo foi comparar o desempenho dessas duas abordagens. Métodos: Este foi um estudo prospectivo e randômico. No total, 80 pacientes foram incluídos no estudo e divididos em dois grupos denominados Grupo C (abordagem transversal clássica no eixo curto) e Grupo SF (abordagem sem seringa oblíqua no eixo longo) por meio de randomização gerada por computador. O desfecho primário foi o tempo médio para a visibilização do fio-guia na veia jugular interna (tempo de execução). Os desfechos secundários foram o número de passagens da agulha, o número de punções da pele e as complicações entre os dois grupos. Resultados: Os dados demográficos e hemodinâmicos não foram significativamente diferentes. O tempo médio de execução foi de 54,9 ± 19,1 segundos no Grupo C e 43,9 ± 15,8 segundos no Grupo SF. Diferenças significativas foram observadas entre os grupos (p = 0,006). O número médio de passagens da agulha foi de 3,2 (± 2,1) no Grupo C e 2,1 (± 1,6) no Grupo SF. Houve diferença estatisticamente significativa entre os dois grupos (p = 0,002). O número de punções da pele foi de 1,6 (± 0,8) no Grupo C e 1,2 (± 0,5) C no Grupo SF (p = 0,027). Conclusão: A técnica sem seringa apresentou tempo de execução, número de passagens da agulha e número de punções da pele menores. Além disso, essa técnica permite acompanhar o progresso do fio-guia com visibilização ecográfica contínua e o procedimento não precisa de auxílio durante a inserção do cateter. Ou seja, sem seringa é uma técnica eficaz, segura e rápida que pode ser usada para a colocação de cateter em veia jugular interna.

Variations of the external and internal jugular veins: a fetal study / Variaciones de las venas yugulares externas e internas: estudio fetal

SUMMARY: The external jugular vein (EJV) is formed by the union of the posterior division of the retromandibular vein and posterior auricular vein, while the internal jugular vein (IJV) is a continuation of the sigmoid sinus. A number of variations in the formation, lengths and drainage patterns of EJV and IJV have been documented in adults, however there is a paucity of literature regarding fetal studies. This study aimed to highlight variation patterns of external and internal jugular veins in 40 fetuses (n=80). This study included the bilaterally dissection of the neck region in 40 fetuses between the gestational ages of 15-28 weeks at the University of KwaZulu-Natal as per Grants Dissector. This study observed three variations in the pattern of the EJV and IJV. With regard to the EJV, duplication occurred on the sternocleidomastoid muscle in 4 % of the specimens sampled in this study, which concurred to a study conducted by Olabu et al. (2015) in a Kenyan sample. The "Y-shaped" IJV occurred in 1 % of the specimens, however the "Y-shaped" IJV gave off a tributary to the EJV in 3 % of the specimens sampled in this study. Lalwani et al. (2006) stated a rare venous communication between the EJV and IJV. The knowledge of the variable patterns of the external and internal jugular veins are important to clinicians performing micro-vascular surgeries in head and neck region.

RESUMEN: La vena yugular externa (VYE) está formada por la unión de la división posterior de la vena retromandibular y la vena auricular posterior, mientras que la vena yugular interna (VYI) es una continuación del seno sigmoideo. En adultos se han documentado una serie de variaciones en la formación, las longitudes y los patrones de drenaje de la VYE y la VYI, sin embargo hay escasa literatura con respecto a estudios fetales. Este estudio tuvo como objetivo destacar los patrones de variación de las venas yugulares externa e interna en 40 fetos (n = 80). El estudio incluyó la disección bilateral de la región del cuello en 40 fetos de edades gestacionales entre 15-28 semanas en la Universidad de KwaZuluNatal. Se observó tres variaciones en el patrón de la VYE y la VYI. Con respecto a la VYE, se produjo duplicación en el músculo esternocleidomastoideo en el 4 % de los especímenes, lo que coincidió con un estudio realizado por Olabu et al. en una muestra keniana. La VYI en "Y" se observó en el 1 % de los especímenes, y otorgó un afluente a la VYE en el 3 % de los especímenes muestreados en este estudio. Lalwani et al. describió una rara comunicación venosa entre la VYE y la VYI. El conocimiento de los patrones variables de las venas yugulares externa e interna es importante para los médicos que realizan cirugías microvasculares en la región de cabeza y cuello.

Feasible study of endovascular embolization for treating cerebral arteriovenous malformations via internal jugular vein approach / 中华放射学杂志

Objective To evaluate the feasibility of transvenous embolization treatment for cerebral arteriovenous malformations(bAVM). Methods From November 2016 to April 2017, the information of 6 patients with brain arteriovenous malformation in our center accepting the intravenous radical embolization were collected, who were ruptured bAVM, bAVM with a single drainage vein, not suitable for surgery confirmed by neurosurgeon consultation or explicitly refused craniotomy. The modified Rankin Scale score of five patients were smaller than three before treatment.The location of draining vein flowing venous sinus was shown by rotational DSA and 3D reconstructed images.A liquid embolic agent was injected via Sonic catheter to completely embolism the brain arteriovenous malformation under controlling blood pressure and blocking the blood provisionally.The perioperative complications and modified Rankin Scale score were observed and recorded 30 days after treatment. Results The transvenous embolization treatment was successfully performed in six patients with 7 embolization procedures.There were no definite operation-related complications. the mRS of all cases were ≤1 within 30 days after operation. Conclusion The embolization technique via the internal jugular vein is feasible for bAVM patients with a single drainage vein,while the long-term outcome need more evaluations.

Application of modified supra-clavicular subclavian vein puncture path in the patients with consciousness disorder / 局解手术学杂志

Objective To compare the practicability, reliability and safety of three paths of central venous puncture,namely internal jugular vein,modified supra-clavicular subclavian vein and subclavian vein,for patients with consciousness disorder.Methods The clinical data of 135 patients with consciousness disorder in department of neurology were retrospectively analyzed.These patients were comprised of 40 cases of internal jugular vein puncture(group J),58 cases of modified supra-clavicular subclavian vein puncture(group GS)and 37 cases of subclavian vein puncture(group S).The one-time success rate,total success rate,puncture and catheterization time and complications were compared among the three groups.Results The one-time success rate of group GS(89.7%)was higher than that of group J(77.5%)and group S(59.5%)with significant difference(P<0.05).There was no significant difference in the total success rate between group GS (94.8%)and group J(87.5%)(P>0.05),but they were higher than that of group S(70.3%)with significant difference(P<0.05). The puncture and catheterization time in group GS was shorter than that of group J and group S with significant difference(P<0.05).The to-tal incidence of complications of group GS(5.2%)was lower than that of group J(20%)and group S(29.7%)with significant difference (P<0.05).Conclusion Compared to internal jugular vein and subclavian vein, the modified supra-clavicular subclavian vein puncture path can adapt to more body positions,improve success rate and reduce complications in patients with consciousness disorder.

Feasibility of 18G trocar applied in jugular vein puncture for adults / 局解手术学杂志

Objective To investigate the feasibility of 18G trocar for central venous catheterization in adults.Methods Retrospective analyzed the clinical data of 60 patients with central venous catheterization under local anesthesia.These patients were randomly divided into the control group and the observation group.Selected the internal jugular vein as the site of the puncture catheter.The control group was punc-tured by conventional puncture needle while the observation group was punctured by the 18G trocar.Results There was no statistical differ-ence between the two groups in the success rate of final puncture and catheterization(P>0.05).Compared with the control group,the suc-cess rate of guidewire insert was higher,the puncture operation time was shorter,the pain score during puncture operation was lower,and post-operative patient satisfaction was higher in the observation group.The differences of the two groups were statistically significant(P<0.05). Conclusion 18G trocar can perform central venous catheterization successfully.This method has great advantages for awake patients,and it also worked in some cases with difficult wire insertion.