US-guided Puncture of the Internal Jugular Vein: Complications and Anatomic Considerations

Gordon, Andrew C.; Saliken, John C.; Johns, Daniel; Owen, Richard; Gray, Robin

doi:10.1016/s1051-0443(98)70277-5

Cited by 184 publications

(134 citation statements)

References 14 publications

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“…In expert hands, the traditional technique is considered safe, but the reliability of anatomic landmarks is questionable because anatomic variations involving this vein and its relation to the internal carotid artery are encountered in a substantial number of cases [33,34]. When landmark-based insertion fails, success rates drop 25 % with each repeat attempt, and the number of attempts is closely correlated with the likelihood of complications [9], the most common of which is arterial puncture [6].…”

Section: Internal Jugular Veinmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures. Keywords Vascular access Á UltrasoundRiassunto Gli accessi vascolari utilizzati nella cura dei pazienti comprendono gli accessi venosi centrali e periferici e gli accessi arteriosi. L'incannulamento di accessi venosi centrali è manovra largamente diffusa nella pratica clinica e si rende necessaria per la cura dei pazienti in molteplici contesti. I vasi centrali che usualmente vengono incannulati sono la vena giugulare interna, la vena succlavia e la vena femorale. Nell'incannulamento venoso centrale sia l'eco-assistenza che l'eco-guida real time, pur con una leggera superiorità di quest'ultima, riducono drasticamente le complicanze meccaniche, infettive e trombotiche. La guida ecografica viene utilizzata anche per l'accesso venoso periferico, per l'incannulamento di vasi periferici e di vasi centrali a inserzione periferica (PICC). In questo contesto la guida ecografica aumenta il successo della manovra di incannulamento soprattutto in condizioni di difficoltà, come avviene nei pazienti obesi o nei bambini, e diminuisce le complicanze quali le infezioni catetere correlate e le trombosi venose. L'incannulamento arterioso viene utilizzato per il monitoraggio cruent...

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Section: Internal Jugular Veinmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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“…1). [6][7][8] The use of ultrasonography in experienced hands reduces the number of attempts and arterial punctures compared with the landmark method. After 3 or more attempts at insertion, mechanical complications increase by 6 times compared with a single attempt.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a novel training program for emergency medicine residents in ultrasound-guided insertion of central venous catheters

Woo

Frank

Lee

et al. 2009

CJEM

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Objective: Insertion of central venous catheters (CVCs) is an essential competency for emergency physicians. Ultrasound-guided (USG) insertion of CVCs has been shown to be safer than the traditional landmark technique. There is no clear consensus on effective methods for training physicians in USG insertion of CVCs. We developed and evaluated a novel educational training program in the USG technique for insertion of CVCs. Methods: Sixteen emergency medicine residents volunteered for a pre-and postprogram evaluation study, which was approved by our research ethics board. After their previous experience was determined, each participant was videotaped inserting a USG CVC in the right internal jugular vein on models. Participants then reviewed a Web-based instructional module and had a practical session. Participants were again videotaped inserting a USG CVC. The primary outcome was the change in score before and after the training program, using an expert-validated performance evaluation tool used to review the videotaped performances in a blinded fashion. Participants also completed a questionnaire to measure their satisfaction with the training program and any change in their perceived competence. Results: Participants ranged from residency year 1 to 5. Thirteen of 16 (81%) had never attempted USG insertion of a CVC. Participants reported that the models were realistic. Performance scores (12/19 to 13.2/19) and global ratings assessments (3.5/7 to 5.5/7) improved significantly (p < 0.01; the effect size, Cohen d = 1.12 before and 1.28 after) after the instruction. There was good interrater reliability between evaluators of the videotaped performances regarding performance scores (r = 0.68) and global rating scores (r = 0.75). All participants felt their confidence and technical skills were improved (p < 0.01) and all felt satisfied with the training program. Conclusion: This brief innovative multimethod training program was effective in enhancing emergency medicine resident competence in USG insertion of CVCs.

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“…6,7 The vast superiority of ultrasound guidance is similarly beyond dispute. 8 At our institution the total cost of a temporary CVC placement in radiology is C$250 with an average total procedure time of 15 min. The professional fee for a surgically placed catheter is comparable but in addition there is the added cost of operating room time, anesthetic fee and a longer total procedure time.…”

Section: Discussionmentioning

confidence: 99%

“…First, all punctures are performed using real time sonographic visualization of the vein which has been demonstrated to be superior to blind puncture. 8 This is reflected in the high percentage of first pass and single wall punctures. It has been shown that the most important predictor of CVC placement complications is the number of passes required to gain venous access.…”

Section: Discussionmentioning

confidence: 99%

Image-guided central venous catheters for apheresis

Sadler

Gordon

Klassen

et al. 1999

Bone Marrow Transplant

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Summary:Apheresis is an increasingly important procedure in the treatment of a variety of conditions, sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study sought to determine the safety and success for ultrasound and fluoroscopically guided, non-tunneled dual lumen CVCs placed for apheresis. Prospective data collection was made of 200 attempted CVC placements in the radiology department utilizing real time sonographic guidance. The complications relating to placement were noted in all and the number of passes required for venepuncture and whether a single wall puncture was achieved was recorded in 185 cases. Duration of catheterization and reason for line removal were recorded in all. Our study group included 71 donors providing peripheral blood stem cells for allogeneic transplant. CVCs were successfully placed in all patients, 191 lines in the internal jugular and seven in the femoral vein. 86.5% required only a single pass and 80.5% with only anterior wall puncture. Inadvertent but clinically insignificant arterial puncture occurred in six (3%) cases. In no case did this prevent line placement. There were no other procedure-related complications. 173 (87.4%) catheters were removed the same day. No catheters were removed prematurely. There was one case of prolonged venous bleeding. Our study demonstrates the safety of central venous catheters for apheresis provided that duration of catheterization is short and real-time sonographic guidance is used for the puncture, and guide wire and catheter placement are confirmed fluoroscopically.

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US-guided Puncture of the Internal Jugular Vein: Complications and Anatomic Considerations

Cited by 184 publications

References 14 publications

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

Effectiveness of a novel training program for emergency medicine residents in ultrasound-guided insertion of central venous catheters

Image-guided central venous catheters for apheresis

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