Transcutaneous pressure at which the internal jugular vein is collapsed on ultrasonic imaging predicts easiness of the venous puncture

Abstract

Even though we use ultrasound guidance for central venous puncture, we sometimes experience difficulties. We infer that in such cases the vein is collapsed and that the transcutaneous ultrasound probe pressure at which the vein is collapsed (P (tc)) may predict the easiness of the venous puncture. We measured P (tc) and the diameter of the internal jugular vein in 47 adult patients in our ICU. After successful puncture, we also measured venous pressure (P (v)). The patients were divided into two groups based on the number of puncture attempts: ≥3 attempts constituted the "difficult group" and <3 attempts was considered the "easy group:" 33 patients were in the easy group and 14 patients were in the difficult group. The easy group showed significantly higher P (tc) value (9.3 ± 3.8 vs. 3.5 ± 0.9 cmH(2)O, P < 0.0001) and larger vertical diameter (9.2 ± 3.1 vs. 6.8 ± 2.2 mm, P = 0.013) than the difficult group. We observed a clear border between the minimum P (tc) in the easy group (6 cmH(2)O) and the maximum value in the difficult group (5 cmH(2)O). In conclusion, venous collapsibility and vertical diameter determine difficulty in performing venous puncture.

Artery Buckling: New Phenotypes, Models, and Applications

“…5, 81 In clinical settings, use of real-time ultrasound-assisted guidance during insertion of a central venous catheter into the internal jugular vein can cause collapse of the vein due to transcutaneous pressure produced by the ultrasound probe, which results in failure of venous puncture for catheter insertion. 56 Pulmonary veins do not collapse with negative transmural pressure (internal pressure minus external pressure) due to tethering to interalveolar septa that stabilize vessel walls. 31 Collapse of veins has also been shown to be beneficial in regulating the flow rate during raising of the head for giraffes.…”