Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Abstract

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...

Internal jugular vein thrombosis associated with venous hypoplasia and protein S deficiency revealed by ultrasonography

“…The right IJV was dominant in only 68% of these cases and 23% of the 160 IJVs had a cross-sectional area of 0.4 cm 2 or less. Thus, Ayoub et al [7] suggested that use of USG for CVC should be adopted by new clinicians and experienced practitioners as their first-line treatment, especially in cases of obesity, edema, coagulation disorders, and difficult anatomical landmarks. In this case, if sufficient attention had been paid to the possibility of secondary changes of vessels caused by The diameter of the IJV is smaller than in Fig.…”

A simple maneuver for confirmation of the guidewire during ultrasound-guided internal jugular vein cannulation

“…1 Although the utility of ultrasound has been well established, some problems remain even when ultrasound is used, such as accidental arterial puncture or penetration of the posterior wall of the internal jugular vein. 1,2 To minimize mechanical injury, the use of a micropuncture technique with a fine needle and guidewire has been proposed. 3 It is currently unknown whether the micropuncture technique reduces complications when compared with the larger needle and guidewire method typically used for internal jugular vein cannulation.…”

“…4 Before dilation, it is essential to confirm the guidewire within the venous lumen to avoid severe mechanical injury that may result from dilation. 1 Nevertheless, a standard relatively large guidewire is sometimes invisible on the ultrasound image, 4 and a thin guidewire can be even more difficult to visualize. To overcome this problem, we push the neck skin softly with the index finger just caudal to where the wire penetrates the skin after removal of the needle (Fig.…”

Accesos venosos centrales

“…En la vena subclavia los resultados aún son dispares probablemente por razones anatómicas. En centros que cuentan con ultrasonido, debe ser usado en forma rutinaria en todos los pacientes [12][13][14][15][16][17] .…”