Sonographic guidance when using the right internal jugular vein for central vein access.

Abstract

OBJECTIVE. The intentof thisstudywasto substantiate theadvantages of theuseof sonographic guidancefor centralvenousaccessvia the right internaljugular vein. SUBJECTSAND METHODS. Eightysequential patients requiring central veinaccesswere examined with a hand-held sonography transducer to determine the size, patency, and locationof the right internaljugular vein beforepuncture. Accessto the right internaljugular vein was subsequently performed, under sterile conditions, using sonographic guidance. Periprocedural complications were prospectively recorded. Subsequently, we compared our findingswith publishedreportsof complicationswhen visible and palpableanatomicland marks were used for guidance during cannulation of the internal jugular vein. RESULTS.Amongthese 80patients, theanatomy of therightinternal jugularveinwastypical in only 57 (71%). In another 13 patients (16%), sonography showed a medial position of the right internal jugular vein, anterior to the common carotid artery. In three other patients (4%), the right internaljugular vein was positioned laterally by more than 1 cm. In the remain ing seven patients (9%), the vein was thrombosed. Its diameter, measured without use of the Valsalva maneuver, also varied, measuring 0.5-2.0 cm. Cannulation was achieved in all 73 pa tients with a patent right internaljugular vein. One puncture was required in 68 patients (93%);two puncturesin threeotherpatients(4%); andthreepuncturesin the remainingtwo patients (3%). In no case was the common carotid artery inadvertently punctured. Only one periproce duralcomplicationoccurred, andit wasunrelatedto the useof sonographic guidance. CONCLUSION. Sonographic guidance forcentral veinaccess viatherightinternal jugular vein is safer and more efficient than the traditional landmark approach. 2â€"5]. The traditional method of using ana tomic landmarksto guide cannulation of the right internal jugular vein has yielded various rates for successful access and complications [6][7][8][9]. These rates depend not only on the experi ence of the operator but also on the underlying patency and anatomy ofthe right internal jugular vein. We believe that the use of a hand-held transducer for real-time sonography before the procedure and for guidance during the procedure canimproveaccess to therightinternal jugular vein and limit complications. Subjects and MethodsDuring a 3-month interval, 80 consecutive patients in whom a right internaljugular vein approachwas beingused for centralveinaccesswereexaminedbe fore the procedure with hand-held real-time sono graphic transducers. Either a Sonolayer SSH-140A(ToshibaAmericaMedicalSystems,Carroilton,TX) ora Site-Rite II (Dymax, Pittsburgh, PA)wasused to determinethe size, patency,and locationof the right internal jugular vein before puncture. To simulate the landmark approach, the patient's head was rotated 30'to the leftand scanningwas performedat the apexof bothheadsofthe sternocleidomastoid muscle.Thirty seven males and 43 females 15â€"76 years old were examined. For those patients who proceeded t...

Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter

“…D Di is sc cu us ss si io on n Internal jugular cannulation with sonographic guidance is more likely to result in success as compared to a blind technique, is considered safer, and has also been found to be quicker. [1][2][3][4][5][6] However, portable sonographic devices are not always available, and sometimes achieving central venous access is difficult. Logically, the larger a target, the easier it is to hit and one should aim to maximize the diameter of the RIJ before attempting to cannulate it.…”

The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access: a systematic review and economic evaluation

“…44 Patency refers to the state of the vessel being present with no evidence of thrombosis. The literature recognises central venous catheterisation as a significant risk factor in the formation of a thrombus of the IJV, SV or FV, 45 so that it becomes increasingly likely with repeated procedures (for instance, in the case of chemotherapy patients).…”

“…A case series by Caridi and co-workers, 44 which used 2-D US guidance to assess the patency and physiology of patients scheduled for CVA via the right IJV, also provided a table reviewing the result of this and other studies. 10,19,46 Across the studies, US diagnosed between 9% and 20% of patients as having either a variant anatomy or thrombosed veins, which would have compromised access using landmark techniques.…”

Hypothermic Cardiac Arrest to Remove Right Atrial Thrombi Due to Abdominal Malignancies

“…Central venous lines can also be used for pulmonary artery catheter (PAC) positioning if the patient's comorbidities suggest the monitoring of pulmonary artery pressures, the measurement of cardiac output and mixed venous oxygen saturation. Central venous cannulation should be performed under ultrasound guidance because up to 30% of patients have some abnormalities of the jugular vein anatomy (Carid et al, 1988;Bevilacqua et al, 2005). Hemodynamic monitoring is completed with transesophageal echocardiography, which has gained widespread use in cardiac operating rooms (where this intervention for cavo-atrial invasion is usually performed) because it provides a great deal of information about the heart's global performance during systole and diastole, the valve function and cardiac volume loads, as well as morphologic details on thrombotic cardiac invasion from the inferior vena cava.…”