The LMA and difficulty with internal jugular vein cannulation

Riley, Richard H.; Gaylard, D.G.; Wright, David; Davies, P.

doi:10.1046/j.1365-2044.1999.01223.x

Cited by 13 publications

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“…16,17 Finally, the use of a laryngeal mask airway can displace the sternocleidomastoid muscle and further complicate palpation of the common carotid artery.…”

Section: Anatomical Variantsmentioning

confidence: 99%

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Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Ayoub

Lavallée

Denault

2010

Can J Anesth/J Can Anesth

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Purpose The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach. Principal findings In recent years, several studies were published on the benefits of ultrasound use for central venous catheterization. This technique has evolved rapidly due to improvements in the equipment and technology available. Ultrasound helps to detect the anatomical variants of the internal jugular vein. The typical anterolateral position of the internal jugular vein with respect to the carotid is found in only 9-92% of cases. Ultrasound guidance reduces the rate of mechanical, infectious, and thrombotic complications by 57%, and it also reduces the failure rate by 86%. Cost-benefit analyses show that the cost of ultrasound equipment is compensated by the decrease in the expenses associated with the treatment of complications. In this article, we will review the history of ultrasound guidance as well as the reasons that account for its superiority over the classical anatomical landmark technique. We will describe the equipment needed for central venous catheterization as well as the various methods to visualize with ultrasound. Conclusion To improve patient safety, we recommend the use of ultrasound for central venous catheterization using the internal jugular approach. ObjectivesAfter reading this module, the reader will be able to:1. Understand the rationale behind the use of ultrasound for central venous catheterization; 2. Identify anatomical variations in vascular structures in the neck; 3. Recognize the benefits and limitations related to the use of ultrasound; and 4. Adopt an ultrasound-guided approach in everyday practice.Over the years, anesthesiologists have adopted new technologies that are used for clinical monitoring and intraoperative diagnosis as well as for performing various techniques. These advances assist the anesthesiologist in performing procedures that may be associated with significant complications. One such procedure is central venous catheterization, which can be simplified and made safer with ultrasound. The main objective of this article is to explain the scientific and clinical foundations supporting the role of ultrasound in central venous catheterization. We will focus exclusively on the internal jugular vein approach. 123 Can J Anesth/J Can Anesth (2010) 57:500-514 DOI 10.1007/s12630-010-9291-7 Historical perspectiveThe main indications for central venous catheterization in the operating room or intensive care unit (ICU) include central venous pressure monitoring, the insertion of a pulmonary artery catheter, and the administration of drugs, such as antibiotics, vasopressors, inotropes, and chemotherapeutic agents. These catheters are also used to administer parenteral nutritional support, and they are needed for procedures such as...

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“…16,17 Finally, the use of a laryngeal mask airway can displace the sternocleidomastoid muscle and further complicate palpation of the common carotid artery.…”

Section: Anatomical Variantsmentioning

confidence: 99%

“…16,17 Enfin, l'utilisation du masque laryngé déplace le muscle sternocléidomastoïdien et rend plus difficile la palpation de la carotide commune.…”

Section: Variations Anatomiquesunclassified

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Ayoub

Lavallée

Denault

2010

Can J Anesth/J Can Anesth

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“…(8,9) However, the anatomic relationship of the IJV and the common carotid artery (CCA) has been reported to change significantly in patients after LMA insertion.(10) The degree of overlap between the right IJV and the right CCA was found to be greater after LMA insertion.(10) In our experience, there are many cases of complete overlap between the right IJV and the right CCA after LMA insertion. This means that there is a higher risk of puncturing the CCA and a lower rate of successful IJV cannulation, when IJV cannulation is performed after LMA insertion.…”

mentioning

confidence: 90%

“…(8,9) However, the anatomic relationship of the IJV and the common carotid artery (CCA) has been reported to change significantly in patients after LMA insertion.…”

Section: Introductionmentioning

confidence: 99%

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Optimal head rotation and puncture site for internal jugular vein cannulation after laryngeal mask airway insertion

Gwak

Choi

Song

et al. 2015

smedj

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INTRODUCTIONRecently, the laryngeal mask airway (LMA) is frequently used for patients under general anaesthesia.(1-7) Occasionally, a clinical situation that requires internal jugular vein (IJV) cannulation after LMA insertion is encountered, especially for difficult airways in patients undergoing major surgery. (8,9) However, the anatomic relationship of the IJV and the common carotid artery (CCA) has been reported to change significantly in patients after LMA insertion.(10) The degree of overlap between the right IJV and the right CCA was found to be greater after LMA insertion.(10) In our experience, there are many cases of complete overlap between the right IJV and the right CCA after LMA insertion. This means that there is a higher risk of puncturing the CCA and a lower rate of successful IJV cannulation, when IJV cannulation is performed after LMA insertion. Lieberman et al reported that an increase in head rotation was associated with a higher probability of CCA contact; (11) we postulated that the effect of head rotation would be similar in patients with LMA insertion. If the degree of overlap between the right IJV and the right CCA varies according to the degree of head rotation after LMA insertion, the degree of head rotation with the least amount of overlap can be determined and the risk of CCA puncture can therefore be reduced.The central landmark approach, which is commonly used for IJV cannulation, was shown to have a low success rate in patients with LMA insertion.(12) Takeyama et al recommended the use of a lower puncture point -near the area where the clavicular head of the sternocleidomastoid muscle (SCM) attaches to the clavicle; the CCA was not observed to be in the vicinity of the IJV when the patient was in that position even after LMA insertion.(10) Although the authors performed test punctures at the supraclavicular lower puncture point in 20 patients without any complications, Kim et al (13) opined that the supraclavicular puncture could still be associated with pneumothorax, hydrothorax or cardiac tamponade. Takeyama et al evaluated the puncture point using only a 30° head rotation, (10) without evaluating the effect of different degrees of head rotation. Another commonly used landmark approach for IJV cannulation is the skin point 1.5 cm or 2.5 cm medial to the external jugular vein (EJV). (14) The use of this landmark has not been evaluated in patients with LMA insertion.In the present study, we compared the degrees of overlap between the right IJV and the right CCA as well as the success rates of simulated right IJV cannulation between patients with LMA insertion and patients with endotracheal intubation (E-tube) using ultrasonography. We aimed to find: (a) the optimal degree of head rotation for right IJV cannulation; and (b) a suitable skin landmark for right IJV cannulation after LMA insertion. To achieve these goals, we compared the success rates of simulated right IJV cannulation at different degrees of head rotation and used different skin landmarks for right IJV cannulation.

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Ultraschallgestützte zentrale Venenpunktion bei Erwachsenen und Kindern

Scheiermann

Fh²,

Breitkreutz

2009

Anaesthesist

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Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. Patients with a high risk for difficult vascular access include critical care and emergency patients as well as patients on anticoagulation medication and dialysis. Placement of central venous catheters can be difficult in ventilated patients and if there has been prior surgery in the puncture area. In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.

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The LMA and difficulty with internal jugular vein cannulation

Cited by 13 publications

References 0 publications

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Optimal head rotation and puncture site for internal jugular vein cannulation after laryngeal mask airway insertion

Ultraschallgestützte zentrale Venenpunktion bei Erwachsenen und Kindern

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