The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking

Ho, Anthony M.‐H.; Ricci, Christopher; Ng, Calvin S.H.; Critchley, Lester A. H.; Ho, Adrienne K.; Karmakar, Manoj K.; Cheung, Chi Wai; Ng, Siu-Man

doi:10.1016/j.jemermed.2011.05.033

Cited by 19 publications

(10 citation statements)

References 12 publications

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“…1 2 Different imaging approaches have been described. [6][7][8] The short-axis approach (SAX) allows simultaneous visualization of both artery and vein, but can make needle tip control difficult. 9 10 The long-axis approach (LAX) can optimize needle visualization, but it can be challenging to perform owing to certain anatomical limitations (such as neck length).…”

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confidence: 99%

Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Batllori

Urra

Uriarte

et al. 2016

British Journal of Anaesthesia

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Background: Ultrasound-guided internal jugular venous access increases the rate of successful cannulation and reduces the incidence of complications, compared with the landmark technique. Three transducer orientation approaches have been proposed for this procedure: short-axis (SAX), long-axis (LAX) and oblique-axis (OAX). Our goal was to assess and compare the performance of these approaches. Methods: A prospective randomized clinical trial was conducted in one teaching hospital. Patients aged 18 yr or above, who were undergoing ultrasound-guided internal jugular cannulation, were randomly assigned to one of three intervention groups: SAX, LAX and OAX group. The main outcome measure was successful cannulation on first needle pass. Incidence of mechanical complications was also registered. Restricted randomization was computer-generated. Results: In total, 220 patients were analysed (SAX n=73, LAX n=75, OAX n=72). Cannulation was successful on first needle pass in 51 (69.9%) SAX patients, 39 (52%) LAX patients and 53 (73.6%) OAX patients. First needle pass failure was higher in the LAX group than in the OAX group (adjusted OR 3.7, 95% CI 1.71-8.0, P=0.002). A higher mechanical complication rate was observed in the SAX group (15.1%) than in the OAX (6.9%) and LAX (4%) groups (P=0.047). Conclusions: As OAX showed a higher first needle pass success rate than LAX and a lower mechanical complications rate than SAX, we recommend it as the standard approach when performing ultrasound-guided internal jugular venous access. Further clinical studies are needed to confirm this conclusion.

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confidence: 99%

Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Batllori

Urra

Uriarte

et al. 2016

British Journal of Anaesthesia

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“…Le taux de pneumothorax est théoriquement plus élevé par voie antérieur, à cause du trajet de l'aiguille, longitudinal et orienté vers le dôme pleural dans cette technique [ 10 ]. Au contraire, dans l'abord postérieur, le trajet de l'aiguille, bien plus transversal, met a priori à l'abri de tout pneumothorax [ 11 ].…”

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Une complication exceptionnelle de la pose d’une voie veineuse centrale jugulaire interne: pneumothorax, pneumo médiastin et retro pneumopéritoine et emphysème sous cutané géant

Belkouch¹,

Sirbou²,

Zidouh³

et al. 2015

Pan Afr Med J

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L'association: pneumothorax, pneumo médiastin, retro pneumopéritoine et emphysème sous cutané est connue de longue date comme complication de l'intubation et la ventilation mécanique, de l'endoscopie digestive ou de la chirurgie laparoscopique. En dehors de ce contexte, elle demeure inhabituelle surtout dans le cadre de La pose de voies veineuses centrales puisque le risque encouru est celui d'une brèche pleurale avec pneumothorax, il est surtout lié à la mise en place d'un cathéter central sous-clavier plus que lors de la pose d'une voie centrale par voie jugulaire. Nous rapportons le cas d'une patiente qui a souffert d'un pneumothorax associé à, un pneumo médiastin, un rétro pneumopéritoine et un emphysème sous cutané géant, suite à une tentative de catéthérisation de la veine jugulaire interne par voie postérieure. L'intérêt de cette observation réside dans la rareté exceptionnelle de cette association chez une patiente en ventilation spontanée et dans le mécanisme physiopathologique qu'elle suggère.

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“…The Trendelenburg position, Valsalva maneuver, humming, 6 positive end-expiratory pressure (PEEP), 7 skin-traction method, 8 and lifting the probe straight upward 9 combine the advantages of the short-and long-axis approaches while US-guided IJV cannulation 10,11 primarily focuses on dilating the IJV. Head rotations not only facilitate the visibility of anatomical landmarks for RIJV cannulation by clearing the chin, 12 but they also change the position of the RIJV with respect to the CA.…”

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confidence: 99%

Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation

et al. 2013

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Ultrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheterrelated complications in high-risk hemodialysis patients. For this procedure, clinicians should identify the optimum positions of the RIJV, including its lower overlap with the carotid artery (CA) and high cross-sectional area of the vein. The aim of this prospective randomized study to evaluate the effects of mild ipsilateral head rotation combined with Trendelenburg position on RIJV cross-sectional area and its relation to the CA in adult patients. Forty ASA I-II patients who were undergoing elective surgery were enrolled for this study. The subjects were asked to remain supine in the 15-20Trendelenburg position. Two-dimensional ultrasound was then used to measure the degree of overlap between the RIJV and CA, the cross-sectional area of the RIJV. These measurements were compared between head rotation to the >30 left, <30 left, neutral, and <30 right positions. When the head was in the >30 left position, overlap was seen in 38 of 40 patients (95%). As the head was rotated from >30 left to <30 right, the CA-RIJV overlap (from 95% to 57.5%), and the cross-sectional area (from 14.2 mm to 8.7 mm) significantly decreased. In conclusion, when the head was turned to <30 right, the CA-RIJV overlap significantly decreased, and the cross-sectional area also decreased. When clinicians determine the optimal head position before RIJV cannulation, it is important to consider the advantages and disadvantages of the different head positions from >30 left to <30 right.

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The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking

Cited by 19 publications

References 12 publications

Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Une complication exceptionnelle de la pose d’une voie veineuse centrale jugulaire interne: pneumothorax, pneumo médiastin et retro pneumopéritoine et emphysème sous cutané géant

Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation

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