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Common carotid arteries were taken as reference points and perpendicular axes were used to demarcate the right and left internal jugular veins positions. O: common carotid arteries.
Source publication
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 retrospectivel...
Context in source publication
Context 1
... of IJVs 7 mm were accepted as potentially difficult catheterization and were recorded. 14,15 Both common CAs were taken as reference points for measuring the position of the IJV (Figure 2). The degree of overlap between the IJV and CA was defined as fol- lows: (1) the IJV overlapped 25% of the diameter of the CA; (2) the IJV overlapped 26-50% of the diameter of the CA; or (3) the IJV overlapped >50% of the diameter of the CA. ...
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Citations
... Although specific angles of insertion for injections or catheterizations are recommended in the literature [8], little is known about their influence on the mechanical behavior of the tissue. It is also not known how varying wall stress of different vessels may affect surgical catheterization. ...
For surgical catheterization training applications, realistic and effective materials are desired. In this study, the relevance of a needle puncture angle and a simulated wall stress on different elastic materials were determined in a previously developed experimental setup. Both settings were considered individually in two new setups. In addition, a control setup with neither angle nor prestress was designed. During the process of puncturing the samples of two materials (Replisil 9N and Formlabs Elastic 50A), force–displacement values were collected, and three predefined parameters evaluated. The differences between the angled/stressed groups and the control group were analyzed. The additively processed material required a significantly higher force to puncture than the conventional one (p < 0.001). Moreover, a needle angulation of 45° required more force than puncturing orthogonally. Prestressing the samples did not clearly influence the resulting force. An evaluation of relative parameters showed that the investigated materials behaved differently but not linearly differently under the influence of needle angle and prestress. Therefore, it is essential to evaluate the properties and suitability of materials for surgical training models in appropriate experimental setups considering multiple parameters.
... In a review of 123 consecutive patients who had a CT, the right internal jugular (RIJ) had an average diameter of 15.6 mm versus 11.7 left internal jugular, the overlap with the carotid artery was not significantly different comparing right to left, and depth of the skin to vein was also similar (Ozbek et al. 2013). The authors also examine the incidence of veins less than 7 mm, which was 4.4% for RIJs and 21.9% for left internal jugular veins. ...
The reduction of complications is an integral theme of VHP; complications can occur during or post insertion. This chapter examines insertion-related complications including arterial puncture, nerve damage, and air embolus. The relationship between catheter complications and insertion site is explored including peripheral vein, internal jugular, axillary, and femoral-placed CVADs. Methods for clinicians to reduce insertion-related complications are discussed, including thorough patient assessment with pre-assessment of vasculature using ultrasound, visualization aids, and real-time imaging during the insertion.
... The reported incidence of anterolateral location of the IJV in relation to the CCA was between 70.8% and 82%. 12,13 When the patient's head is rotated >30 , overlap between the two vessels significantly increased (57.5% vs. 95%). 14 There are several limitations in our study. ...
Background:
The ipsilateral nipple has been used as a directional guide for needle advance during internal jugular vein (IJV) catheterization. We attempted to validate the utility of the ipsilateral nipple during IJV catheterization.
Methods:
One hundred and two patients scheduled for elective surgery were enrolled. In the 15° Trendelenberg position with 30° head rotation, the apex of the triangle formed by the sternocleidomastoid muscle and the clavicle was identified. The angle formed by the line connecting the apex and the ipsilateral nipple and the actual course of the IJV was measured. The distance between the apex of the anatomical triangle and the IJV center identified were measured via ultrasound.
Results:
The angle formed by the line connecting the apex and the ipsilateral nipple and the IJV was 16 ± 7.6° and was greater in females than males (14.8 ± 1.1 vs 17.4 ± 1.0°, P = 0.043). Regression analysis showed that height, weight, gender, and age did not affect the angle as an independent factor. The apex of the anatomical triangle was 0.5 cm medial to the IJV center and was shorter in females compared to males (0.33 ± 0.12 vs 0.6 ± 0.09 cm, P = 0.039).
Conclusion:
Our study shows that when the needle is inserted at the apex of the anatomical triangle directed towards the ipsilateral nipple, it crosses the IJV at 16°. Since the common carotid artery is usually medial to the IJV, directing the needle towards the ipsilateral nipple seems to be a safe way to avoid the common carotid artery and successfully puncture the IJV.
... Catheterization, based on superficial landmarks is done in 1 attempt in about 20% of the time, while with the help of bedside ultrasonography, catheterization can be done with fewer complications and higher success rate (8). In a study aiming to determine the proper angle of needle insertion in the sagittal plane on the internal jugular vein, it was determined that a 16 degree insertion angle from the sagittal plane results in an increase in the probability of successful catheterization (9). In our study, mean sagittal angle of needle tilt from the horizontal line was about 36 degrees, which is vastly different from the mentioned study. ...
Introduction:
Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization.
Methods:
In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient's head rotation.
Result:
114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09.
Conclusion:
Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results.
... Sağ İJV kanülasyonu geleneksel olarak kör yöntemle, baş karşı tarafa çevrilip anatomik işaretlemeler dikkate alınarak uygulanmaktadır. Bu uygulama sırasında karotis arterin (KA) delinmesine bağlı nadir de olsa hayatı tehdit edebilecek komplikasyonlar görülebilmektedir (1,2). Bu nedenle pek çok komite İJV kanülasyonunun ultrason eşliğinde yapılması gerektiğini savunmaktadır (3). ...
... USG kullanılarak yapılan anatomik çalışmalarda başın nötrale yakın tutulmasının KA ve İJV' nin üstüste binme oranını azalttığını böylece İJV'nin arka duvarının geçilmesi halinde arterin delinme ihtimalinin azalacağını bildirmiştir (4)(5)(6)(7)(8). Ancak ultrason ile anatomik çalışmalar yapmak BT ile yapmak kadar güvenilir değildir (2,16) ve ultrason probunun konumundaki ufak oynamalar görüntüyü değiştirebilmektedir (2,17). Baş laterale çevrildiğinde KA palpasyonu ile KA'nın palpe edilip bu noktanın lateralinden uygulamanın yapılmasındaki gerekçe genellikle jugular venin KA nın lateralinde seyretmesidir (1,17). ...
... Baş laterale çevrildiğinde KA palpasyonu ile KA'nın palpe edilip bu noktanın lateralinden uygulamanın yapılmasındaki gerekçe genellikle jugular venin KA nın lateralinde seyretmesidir (1,17). Ancak baş nötral pozisyonda tutulduğunda İJV ve KA arasındaki ilişki bozulabilir (2). Bu nedenle bu çalışma öncesi çekilmiş BT görüntüleri retrospektif olarak radyoloji uzmanı tarafından aynı seviye kullanılarak değerlendirilmiş ve hastaların %67,3 ünde İJV nin KA'nın anterolateralinde kalan hastalarda ise lateralinde olduğu doğrulanmıştır. ...
Objectives: Internal jugulary venous cannulation (IJV) should be performed in patients while maintaining a neutral head position
for a variety of clinical conditions. However, in this position, the landmark that should be used is unclear. Our aim was to evaluate the
success rate of right IJV cannulation guided by carotid artery (CA) palpation in a patient with a neutral head position. Materials and
methods: The prospective randomized study was designed as two parts. Part 1: Prior to this study we conducted a priliminary evalu-
ation with CT scans of 30 consecutive patients to determine the relationship with right IJV and the CA. Part 2: A total of 150 patients
who planned right IJV cannulation were included in the study. Each patient’s head was placed in the neutral position. Under general
anesthesia, the patient was positioned in the Trendelenburg position and ventilation was provided with a positive end-expiratory pres-
sure. Right IJV cannulation was performed by ten different clinicians using CA palpation to guide the needle, which was not angled
eighter medially or laterally. The primary outcome variable was the cumulative success rate, which was defined as right IJV puncture
achieved in the first 3 attempts using a needle. Results: The cumulative success rates on the first 3 attempts were 96.7%. No differences
were observed between the clinicians. CA puncture did not occur in any patient. Conclusion: CA guided right IJV cannulation can
be used effectively due to its high success rate in patients whose heads are maintained in a neutral position.
Introduction: Obesity is one of the most important risk factors for complications of internal jugular vein (IJV) cannulation. The efficacy and safety of positive end-expiratory pressure (PEEP) are still under debate in obese patients. The aim of this prospective randomized ultrasound study was to investigate effects of different PEEP levels on the cross-sectional area (CSA) of right IJV and overlap with carotid artery (CA) in anesthetized obese patients. Materials and Methods: Seventy-two obese patients undergoing various elective surgeries under general endotracheal anesthesia were enrolled. We measured CSA of right IJV, margin of safety (MOS), and degree of overlap between CA and IJV at PEEP 0 (P0), 5 (P5), and 12 (P12) cm H2O levels. We defined a ≥20% increase in CSA as clinically relevant. Results: Data were collected for all the 72 patients enrolled in the study. Application of 12, but not 5 cm H2O PEEP, resulted in a clinically significant increase in CSA of right IJV. When compared to P0, application of P5 and P12 increased both degree of overlap (p < 0.001 each) and MOS (p < 0.001 each). None of the patients experienced severe hypotension or bradycardia. Conclusions: Application of 12 cm H2O PEEP provides a clinically significant increase in CSA of right IJV without relevant reduction of MOS in anesthetized obese patients.
Implanted ports (IPs) are an essential device for many patients who require long-term vascular access. IPs offer some advantages over other central venous access devices, such as lifestyle, body image benefits and lower infection rates. A typical implantation site for a port is the anterior chest wall. For some patients with breast cancer who have metastatic chest wall disease this site may lead to problems with the function of the device if disease spreads to the port site. One option for this patient group is to place the implanted port over the trapezius muscle. This article discusses six patients, all of whom had metastatic breast cancer with some degree of subcutaneous disease on the anterior chest wall. Three patients had received trapezius port placements and three had anterior chest wall placements. A retrospective review of the patients' medical records was undertaken from the time of insertion until removal or until the patient died. The anterior chest wall group of patients had their devices in for an average of 368 days vs 214 in the trapezius group. The total complications were higher in the anterior chest wall group (7 vs 2 in the trapezius group). Disease spread to two of the devices in the anterior chest wall group meaning the devices could no longer be used. The trapezius approach appears to be a safe and a reliable form of vascular access and may offer fewer complications than the traditional method of anterior chest wall placement when standard anterior chest wall approach is not suitable.
Background
Catheterisation of the internal jugular vein (IJV) can be difficult in infants. We aimed to evaluate whether a simple manoeuvre, a slight caudo-lateral traction of the ipsilateral arm (CLTIA), could decrease the head rotation-induced overlap of the IJV to the carotid artery (CA) in infants.Methods
Twenty-five infants were included. The patients were placed in the 10° Trendelenburg position with a shoulder roll. On both sides of the neck, ultrasound images were obtained in a transverse orientation before and after the CLTIA at 0°, 40°, and 80° of head rotation, respectively. On each image, CA overlap was calculated as follows: CA overlap (%) = (overlap distance/CA diameter) × 100.ResultsThe CLTIA decreased CA overlap (%) in 0°, 40°, and 80° of head rotation on the right side of the neck [14 (interquartile range, IQR 0–32) to 0 (IQR 0–14), 24 (IQR 0–46) to 0 (IQR 0–33), and 31 (IQR 12–58) to 23 (IQR 0–34); all P < 0.01] and on the left [29 (IQR 7–61) to 19 (IQR 0–44), 40 (IQR 21–65) to 31 (IQR 0–46), and 44 (IQR 29–97) to 33 (IQR 14–69); all P < 0.01], respectively.Conclusion
The CLTIA successfully reduced the overlap between the IJV and the CA in infants. However, further study should be needed to evaluate the clinical usefulness of the CLTIA during the IJV catheterisation.
Ultrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheter-related 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 15-20° Trendelenburg 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.
