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A) Cross-sectional view of the left internal jugular vein with needle in lumen. B) Longitudinal view of guidewire in lumen of left internal jugular vein.
Source publication
This is a case report describing the ultrasound-guided placement of a peripheral intravenous catheter into the internal jugular vein of a patient with difficult vascular access. Although this technique has been described in the past, this case is novel in that the Seldinger technique was used to place the catheter. This allows for safer placement o...
Contexts in source publication
Context 1
... given the patient's relatively well appearance, and the desire to avoid dilation of the left internal jugular vein (one of the patients last viable dialysis access sites), we opted to place an AccuCath ® 2.25" BC catheter in this central vein under ultrasound guidance. The neck was prepped in sterile fashion and the left internal jugular vein was cannulated under dynamic ultrasound guidance using a Zonare Z.One PRO ultrasound system (Mountain View, California) (Figure 2a). The guidewire was then gently advanced into the vein (Figure 2b), and the catheter was subsequently advanced over the wire. ...
Context 2
... neck was prepped in sterile fashion and the left internal jugular vein was cannulated under dynamic ultrasound guidance using a Zonare Z.One PRO ultrasound system (Mountain View, California) (Figure 2a). The guidewire was then gently advanced into the vein (Figure 2b), and the catheter was subsequently advanced over the wire. One liter of IV normal saline was infused after which the patient's blood pressure improved. ...
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Background:
Arteriovenous (AV) fistulas are considered the gold standard for ensuring safe and long-term vascular access in patients with haemodialysis-dependent end-stage renal disease. However, previous studies demonstrated that high-flow AV fistulas might add additional cardiovascular burden in the post-transplant setting, leading to frequent f...
Introduction: The number of people with diabetes is increasing in every country. Recent estimates put the prevalence at 8.3% of adults, with a predicted rise to 10.1 in 2035 [1]. Although less than 1% of patients with diabetes require definitive haemodialysis, this still represents a significant number who may require arteriovenous fistula creation...
Aims:
Patients with high-flow arteriovenous (AV) access are at risk of developing high-output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited...
Over the past decades, ultrasound (US) has gained its place in the armamentarium of monitoring tools in the intensive care unit (ICU). Critical care ultrasonography (CCUS) is the combination of general CCUS (lung and pleural, abdominal, vascular) and CC echocardiography, allowing prompt assessment and diagnosis in combination with vascular access a...
Citations
... For the right iliac approach, we used the lengths of 40-55 cm depending on the patient size while for the left side, 55 cm length was used due to the long course of the left iliac vein to the right atrium (atriocaval angle). e iliac vein was approached by using the Seldinger technique [10]. e patient was placed in the supine position, and the patency of the iliac veins was assessed using Doppler ultrasound. ...
Background:
Providing well-functioning vascular access is crucial for patients undergoing chronic hemodialysis. Peripheral arteriovenous fistulas and grafts are the preferred accesses in hemodialysis patients. Patients with bilateral obstruction of internal jugular veins and subclavian veins require a suitable vascular access. Thus, the insertion of iliac vein tunneled cuffed catheters (TCCs) by interventional nephrologists may be a good option for these patients. We aimed to evaluate the outcomes of iliac vein TCCs in patients lacking other vascular options.
Methods:
80 tunneled cuffed hemodialysis catheters were inserted through the iliac veins of 80 patients with an end-stage kidney disease. Catheter insertion was guided by Doppler ultrasonography followed by plain radiography to detect the catheter tip and exclude complications.
Results:
The insertion success rate was 100%. 25 patients developed catheter-related infections. The mean survival time per catheter was 328 days. At the end of the study, 40 catheters were still functioning, 15 patients were shifted to continuous ambulatory peritoneal dialysis and 5 patients were referred to the interventional radiology department for insertion of transhepatic inferior vena cava tunneled catheters. Resistant catheter-related infection was the main cause of catheter removal in 11 patients (17.5%) in this study. Catheter malfunction was the second most common cause of catheter removal in 9 patients (11.25%).
Conclusion:
This study concluded that iliac vein TCCs can provide suitable vascular access in hemodialysis patients with bilateral obstruction of internal jugular veins and subclavian veins.
... Nine prospective studies have shown that jugular placements of PIV catheters are associated with good safety and efficacy outcomes; however, results vary across studies. Across four observational studies with a total of 147 patients, the first puncture success rate is reported to range between 50.0% and 88.0% [4,[51][52][53][54]. Among six studies with a total of 1172 patients, the overall success rate was reported to be between 55.0% and 100% [35,[51][52][53][54][55]. ...
... Across four observational studies with a total of 147 patients, the first puncture success rate is reported to range between 50.0% and 88.0% [4,[51][52][53][54]. Among six studies with a total of 1172 patients, the overall success rate was reported to be between 55.0% and 100% [35,[51][52][53][54][55]. Across four studies of a total of 1,036 patients, the average number of punctures experienced by patients with DVA was reported between 1.0 and 1.4 punctures [28,51,54,55]. ...
... Among six studies with a total of 1172 patients, the overall success rate was reported to be between 55.0% and 100% [35,[51][52][53][54][55]. Across four studies of a total of 1,036 patients, the average number of punctures experienced by patients with DVA was reported between 1.0 and 1.4 punctures [28,51,54,55]. In eight different studies with a total of 1,181 patients, the median time to puncture ranged between 3.1 and 8.1 minutes [4,28,35,[50][51][52][53]55]. ...
Introduction:
Timely placement of vascular access devices is critical during emergent clinical situations; however, challenges in peripheral access can be a common occurrence. Historically, emergency teams have used various approaches to gain peripheral vascular access in situations where traditional means were not feasible; these options have included peripheral venous cutdown, ultrasound-guided peripheral intravenous catheters (PIVs), longer PIVs, central catheters, and intraosseous devices. Each of these options have associated strengths and limitations depending on the clinical situation.
Areas covered:
This narrative review reports on the burden of difficult venous access situations and discusses the evidence, and strengths and limitations of vascular access options to help address this challenge. Although first puncture success rates can be high when using alternative methods, significant challenges can include increased procedure time and greater risk of complications. The Easy-Internal Jugular (Easy-IJ) technique is a newer alternative option for patients with difficult venous access that is demonstrated to be safe and effective in emergency care.
Expert opinion:
Moving forward, additional clinical studies are required to fully characterize the outcomes associated with the Easy-IJ technique and guidewire-assisted intravenous catheters, as well as to inform guideline development for more comprehensive recommendations on managing challenging or difficult peripheral access situations.
... We used Seldinger technique for intravenous line placement to insert the cuffed HD catheters. 14 ...
Introduction:
Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view.
Method:
The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal.
Findings:
The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%).
Discussion:
End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.
... This line has been suggested to be superior to central venous access due to speed of placement and lower risk of complications (e.g., needle injury, catheter malposition, etc.). [40][41][42][43][44] However, the peripheral internal jugular (PIJ) line also carries inherent risks. Given the proximity to central access, providers must be careful to avoid introducing an infection into the central bloodstream. ...
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
A Prospective, Randomized, Controlled Comparison of First Attempt Success Between an Intravenous Catheter System With a Retractable Coiled Tip Guidewire and Conventional Peripheral Intravenous Catheters
Introduction
The aim of this study is to compare an intravenous (IV) catheter system which uses a retractable guidewire (RG-IV) designed to facilitate IV placement with a conventional IV (C-IV) catheter control.
Materials and methods
A prospective, randomized design was used. Patients referred to interventional radiology for outpatient procedures were offered participation. Enrollment occurred between August and November 2013. Patients were assigned to receive the RG-IV or C-IV in a 1:1 randomization scheme. After assignment, up to three attempts by a registered nurse occurred with the assigned device; if all three attempts failed, crossover to the other device occurred. The primary outcome variable was first-attempt success at IV placement. Secondary outcome variables included patient and clinician satisfaction, number of attempts, and time to successful placement. Two hundred twenty patients were enrolled (139 men, 81 women) in the study.
Results
Of the 220 patients, two were withdrawn prior to IV attempt leaving 218 subjects, 109 in each group. First attempt success (77% RG-IV vs. 82% C-IV, p = 0.5), number of attempts to achieve IV access (1.26 RG-IV vs. 1.29 C-IV, p = 0.98), and time to achieve IV success (2.9 minutes RG-IV vs. 2.7 C-IV, p = 0.82) did not differ between groups. Patient satisfaction with insertion was higher in the C-IV group (4.5/5 vs. 3.9/5, p<0.001) although comfort comparison was not (3.3/5 RG-IV vs. 3.5/5 C-IV, p = 0.15).
Conclusions
In an interventional radiology outpatient population, the RG-IV and C-IV were comparable in first-attempt success, number of attempts, and time to achieve IV success. Patient satisfaction was higher with C-IV.
