External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

Abstract

Central venous access plays an increasingly important role in the delivery of modern care. Many studies on the venous access sites for central venous catheterization have been conducted. [1][2][3][4][5] The preferred access site for central venous catheter placement continues to be the right internal jugular vein (IJV).When the right IJV is not available for central venous access, the second access site remains variable. Although the left IJV and the subclavian veins (SCV) have been used for second access, several studies suggest that both SCVs and the left IJV should be avoided because of a high incidence of procedural complications (pneumothorax, arterial puncture) as well as central venous stenosis and thrombosis. [2][3][4][5][6] The left IJV is also related with a high incidence of catheter malfunction. 6 Some authors believe that the second venous access after the right IJV should be the right external jugular vein (EJV). 3,7 One reason for use of the right EJV is its relatively straightforward course and short length, which are very similar to those of right IJV. A second reason is that the EJV is easily accessed, given its superficial location on the neck.7 However, it is suggested that the incidence of malpositioned catheters via the EJV approach makes this route unreliable. 8 To decrease the incidence of catheter dislodgement, vessel wall erosion, thromboembolism and catheter malfunction, accurate positioning of the catheter tip near or at the junction of the superior vena cava (SVC) and right atrium (RA) is necessary.9 It is possible to decrease the incidence of malposition with the use of additional techniques. French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. Results: In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. Conclusion: Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

Ultrasound-guided central venous tip confirmation via right external jugular vein using a right supraclavicular fossa view

“…However, the incidence of CVC misplacement is higher. [12][13][14][15] In this study, a supraclavicular fossa view allows the determination of the CVC's depth and prevents misplacement via the right EJV. These findings suggest that a right supraclavicular fossa view is useful for facilitating CVC insertion under realtime US guidance.…”

Randomised controlled trial of central venous catheterisation through external jugular vein: A comparison of success with or without body manoeuvres

“…[ 6 ] with inherent angulations in its passage through the cervical fascia and at the termination into the SCV. [ 6 14 15 ] At the same time, the diameter of EJV-SCV junction is: 5.5 ± 1.6 mm through which J-wire might not traverse. [ 12 ] Moreover, EJV is one of the variable veins, with the various anatomical variations been described by Yadav et al .…”

Towards Optimal Central Venous Catheter Tip Position

“…A safe method for ECG-guidance of the CVC follows (using CVC kits from B.Braun, Melsungen, Germany): Insert the guide wire in the vein to a depth not to exceed 10-12 cm. Introduce the catheter over the wire, up to the black marking that indicates the point at which the tip of the wire levels with the distal port opening (Figure 1) [19]. To make sure that this method works a sterile connection cable with a crocodile clip has to be clamped to the guide wire [19].…”

“…Introduce the catheter over the wire, up to the black marking that indicates the point at which the tip of the wire levels with the distal port opening (Figure 1) [19]. To make sure that this method works a sterile connection cable with a crocodile clip has to be clamped to the guide wire [19]. The other end of the connection cable joins a switch box (e.g.…”