Humming Is as Effective as Valsalva’s Maneuver and Trendelenburg’s Position for Ultrasonographic Visualization of the Jugular Venous System and Common Femoral Veins

Lewin, Matthew R.; Stein, John C.; Wang, Ralph; Lee, Marsha M.; Kernberg, Martin; Boukhman, Milana P.; Hahn, In‐Hei; Lewiss, Resa E.

doi:10.1016/j.annemergmed.2007.01.024

Cited by 27 publications

(23 citation statements)

References 13 publications

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“…The Trendelenburg position, Valsalva maneuver, humming, and positive end expiratory pressure (PEEP) application are known to increase IJV diameter. 17,18 When the head is in the neutral position, the degree of overlap decreases, especially between the right jugular vein and the CA, and therefore the risk of CA puncture is decreased. 10 In order to verify this information, Lamperti et al 10 studied the effects of US-guided IJV catheterization with the head in a neutral position and turning it to the side on the rates of success and complications in1332 adult patients.…”

Section: Discussionmentioning

confidence: 99%

Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study

et al. 2013

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Purpose: The aim of this study is to determine the optimal angle of needle entry in the sagittal plane for internal jugular vein (IJV) catheterization with the central approach while the head is in the neutral position. Methods: The contrast-enhanced carotid artery computed tomography angiographies of 123 consecutive patients were retrospectively reviewed. The point of merger between the sternal and clavicular heads of the sternocleidomastoid muscle was assumed as a clinical entry (CE) point. The angle between CE point and the center of the IJV, the depth, diameter of the vessels and the degree of overlap between the IJV and carotid artery (CA) were measured. Results: The angles between the CE point and the center of the IJVs were similar, 7°± 13°medial and 8°± 12°medial on the right and the left side, respectively. The center of IJVs from the CE point was between 0°and 16°toward the medial in 79.8% on the right side and 89.9% on the left side of patients. The diameters of the right IJVs were greater than the left IJVs (p = 0.001). The depth from the skin and overlap between IJV and CA did not vary between the two sides. Conclusions: When a central approach is used for right internal jugular vein (RIJV) cannulation with a neutral head position, the orientation of the angle of needle entry (i.e., 16°) medially in the sagittal plane may quadruple the success rate of RIJV catheterization compared to the success rate of a laterally oriented angle of entry as recommended by the classic method.

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Section: Discussionmentioning

confidence: 99%

Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study

et al. 2013

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“…A sufficiently dilated EJV was used in this study. Since the use of the Valsalva maneuver or humming can produce venous distension (21), an EJV with a diameter greater than 5 mm is required for the insertion of a 15 F peel-away sheath for placement of a 14.5 F tunneled hemodialysis catheter.…”

Section: Discussionmentioning

confidence: 99%

Placement of a Hemodialysis Catheter using the Dilated Right External Jugular Vein as a Primary Route

Park

Shin

2010

J Korean Soc Radiol

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The number of patients with end stage renal disease requiring catheter-based hemodialysis has increased in recent decades. Catheter-based hemodialysis is commonly used during the time it takes for arteriovenous fistula maturation. Conventional venous access sites such as the subclavian vein (SCV) and internal jugular vein (IJV) had been used for catheter placement. However, the SCV should be preserved from catheterization, with consideration of the risk of venous stenosis or thrombosis as complications after a procedure in a patient where fistula or graft creation is planned. The rate of complications for an SCV approach is higher than for an IJV approach. The IJV has become the preferred pri- Results: Technical success was achieved for 41 patients (98%). Catheter placement was unsuccessful in one patient due to narrowing of the EJV. The catheter dwell time ranged between 14 and 305 days (mean; 76 days, total catheter days: 3,111 days). A total of 26 hemodialysis catheters were removed due to complications (n=2) and termination of hemodialysis via the hemodialysis catheter (n=24). There was air embolization (n=1) and catheter kinking (n=3) during procedures and catheter related infections (n=2) during the follow-up period. The incidence of catheter related infection was 0.06 per 100 catheter days. No cases of catheter malfunction or symptomatic venous thrombosis were observed. Conclusion:We suggest that a dilated right EJV could be considered as a preferred primary route for hemodialysis catheter placement with easy access.

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“…A number of maneuvers have been adopted to increase the IJV diameter and cross-sectional area. These include head rotation [4], head-down tilt [5], Valsalva maneuver [6], humming [7], Trendelenburg tilt [8], abdominal compression [9], and passive leg elevation [10]. Positive end-expiratory pressure increases IJV cross-sectional area [11].…”

Section: Introductionmentioning

confidence: 98%

Optimal shoulder roll height for internal jugular venous cannulation: a study of awake adult volunteers

Chang

Wang

Ting

et al. 2012

Journal of Clinical Anesthesia

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Humming Is as Effective as Valsalva’s Maneuver and Trendelenburg’s Position for Ultrasonographic Visualization of the Jugular Venous System and Common Femoral Veins

Cited by 27 publications

References 13 publications

Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study

Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study

Placement of a Hemodialysis Catheter using the Dilated Right External Jugular Vein as a Primary Route

Optimal shoulder roll height for internal jugular venous cannulation: a study of awake adult volunteers

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