Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients

Abstract

Background:The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation.Settings and Design:Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was used for qualitative variables.Results:The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients.Conclusions:USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.

Ultrasound Guidance for Central Venous Access: Current Evidence and Clinical Recommendations

“…Despite the traditional methods used to differentiate venous from arterial cannulation (blood color, pulsatility, transducing pressure, and blood gas analysis), the incidence of arterial catheterization has been reported to range from 0.1% to 7%. 26,[45][46][47] Ultrasound may prevent such inadvertent arterial dilatation and catheterization 47 by visualization of the guidewire within the vein, visualization within the brachiocephalic trunk, 48 or visualization of guidewire in the SVC, RA, or IVC. [49][50][51][52] Reducing complications…”

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

“…Internal jugular vein (IJV) catheterization has a lower risk of mechanical complications than the subclavian vein [2]. The common mechanical complication following IJV catheterization is puncture of the common carotid artery (CCA) and its incidence was found to be from 10% to 12% using landmark technique catheterization compared to 1-4% using ultrasound-guided catheterization [3][4][5]. The risk of accidental CCA puncture may be related to anatomic variations of the IJV, specifically, its shape and relationship to the artery.…”

“…Current evidence-based recommendations emphasize that US should be used whenever possible to guide this procedure [2,6]. US guidance increases the central venous catheterization success rate, reduces the time and number of attempts until successful catheterization and reduces the incidence of mechanical complications when compared with the traditional landmark approach [3][4][5]7,8].…”

Optimization of Right Internal Jugular Central Venous Catheter Length in Pediatric Cardiac Surgical Patients

“…8 Anatomic complications during central line placement resulting from imprecise needle insertion include nerve injury; vein laceration; parenchymal lung injury; and most importantly, injury to the carotid artery. [8][9][10] In addition, precise localization of the distal CVC tip within the SVC has been defined to be at a level above the pericardial sac. 11 Adoption of an optimal location is imperative because variable anatomic localization and imprecise advancement may lead to catheter migration through the SVC or right atrial wall, resulting in life-threatening complications of hemothorax or cardiac tamponade.…”

“…Ultrasound has been proven to increase the successful initial attempt at venous cannulation in pediatric and underweight adult cardiac surgical patients. 10 In conclusion, reproducible and reliable methods are needed to provide standardization and ensure safety of CVC placement in children, irrespective of body size, to minimize the risk of complication. The approach proposed by Maddali et al provided such a model that may be adopted in both the conduct and instruction of techniques for internal jugular vein CVC insertion.…”