A safer technique of internal jugular venipuncture: Experience with 320 cases

Khatri, Vijay P.; Espinosa, Manuel H.

doi:10.1016/1053-0770(94)90199-6

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…1,2 We described a new method for cannulating the internal jugular vein (IJV) that we developed from the anatomical relations noted during radical neck dissections. 3 A retrospective review of our method revealed a 91% success rate of IJV cannulation and a complication rate of 0.6%. 3 We used duplex imaging to determine the reliability of surface landmarks in locating the IJV.…”

Section: Discussionmentioning

confidence: 99%

“…8 It is clear that head rotation increases the incidence of carotid artery puncture, the most common reported complication of IJV venipuncture. 3 After CEA, one would expect the carotid artery to be less mobile because of adhesion formation. Surprisingly, even in the CEA group, the carotid artery moved behind the IJV on neck rotation.…”

Section: Discussionmentioning

confidence: 99%

“…Our method of gaining access to the IJV was based on anatomy noted during radical neck dissections, and the surface landmarks were found to be clinically reliable and safe. 3 In this study we prospectively evaluated the accuracy of our method of gaining access to the IJV using color flow duplex imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The exact technique of performing the venipuncture using this method has been previously described. 3 Briefly, the surface landmarks are marked on the patient, who is then placed in the Trendelenburg position. The skin over the access point is infiltrated with 1% lidocaine and the IJV is first located using a 25-gauge needle.…”

Section: Surface Landmarksmentioning

confidence: 99%

“…3 A retrospective review of our method revealed a 91% success rate of IJV cannulation and a complication rate of 0.6%. 3 We used duplex imaging to determine the reliability of surface landmarks in locating the IJV. Percutaneous cannulation of the ipsilateral IJV has historically been considered…”

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confidence: 99%

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The Internal Jugular Vein Maintains its Regional Anatomy and Patency After Carotid Endarterectomy: A Prospective Study

et al. 2001

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ObjectiveTo validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine whether these surface landmarks were altered after neck surgery. Summary Background DataCarotid puncture and pneumothorax continue to be the most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The authors' modified technique of IJV venipuncture was associated with a 0.6% complication rate; notably, there were no instances of carotid artery puncture. Determining the accuracy of this method using duplex ultrasound would enhance the technique's applicability and safety. The authors also hypothesized that previous neck surgery would alter the regional anatomy in relation to these surface landmarks for IJV venipuncture. MethodsThe authors prospectively evaluated 417 IJVs in 209 consecutive patients undergoing carotid duplex imaging before and after carotid endarterectomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of the neck served as a control for each patient. The position of the IJV in relation to the surface landmarks, the mobility of the IJV on neck rotation, and the size, patency, and relation of the IJV to the carotid artery were evaluated. ResultsOverall accuracy of the surface landmarks for locating the IJV percutaneously was 99% for the control group and 95% for the CEA group. With neck rotation, the IJV was located in a more lateral position in relation to the landmarks that would significantly reduce its accessibility. After neck rotation, it was also noted that the carotid artery moved behind the jugular vein in 85% of the patients in both groups. The mean size of the vein and its patency were similar in both groups. ConclusionsDuplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJV anatomy is not altered after CEA.Access to major large central veins is commonly gained percutaneously, and a thorough knowledge of the surface anatomy is essential to ensure successful venous cannulation and minimize mechanical complications. Many clinicians advocate an ultrasound probe to localize the jugular vein before venipuncture, because the success rate of this technique exceeds 95%. 1,2 We described a new method for cannulating the internal jugular vein (IJV) that we developed from the anatomical relations noted during radical neck dissections. 3 A retrospective review of our method revealed a 91% success rate of IJV cannulation and a complication rate of 0.6%. 3 We used duplex imaging to determine the reliability of surface landmarks in locating the IJV. Percutaneous cannulation of the ipsilateral IJV has historically been considered

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surface Landmarksmentioning

confidence: 99%

mentioning

confidence: 99%

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The Internal Jugular Vein Maintains its Regional Anatomy and Patency After Carotid Endarterectomy: A Prospective Study

et al. 2001

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Bilateral duplicated internal jugular veins: Case study and literature review

et al. 2006

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A rare bilateral duplication of the internal jugular vein (IJV) was discovered during cadaveric dissection. From each jugular foramen, a single IJV descended to the level of the hyoid bone then divided into medial and lateral veins. The medial IJVs traveled in the carotid sheath; the lateral IJVs coursed posterolateral to the sheath across the lateral cervical region (posterior triangle) of the neck. On the right side, medial and lateral IJVs entered the subclavian vein separately. C2-C3 anterior rami and the suprascapular artery passed between the medial and lateral IJVs. The right external jugular vein passed aberrantly between the heads of the sternocleidomastoid muscle (SCM) into the subclavian vein anterior to the lateral IJV. On the left side, the medial IJV drained into a large bulbous jugulovertebrosubclavian (JVS) sinus that received six main vessels. The lateral IJV diverged posterolaterally toward the border of the trapezius muscle, received the transverse cervical vein, and then turned sharply anteromedially to drain into the JVS sinus. The lateral IJV also gave an aberrant additional large vein that passed laterally around the omohyoid muscle before entering the JVS sinus. The left external jugular vein paralleled the anterior border of SCM before passing posterolaterally to terminate in the JVS sinus. Jugular vein anomalies of this magnitude are very rare. Determining the frequency of multiple IJVs is hampered by inconsistent terminology. We suggest that IJV duplication differs from fenestration anatomically and, potentially, developmentally. Criteria for characterizing IJV duplication and fenestration are proposed. The mechanism of development and the clinical significance of multiple IJVs are discussed.

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