Ultrasound-guided cannulation of the internal jugular vein in critically ill patients positioned in 30° dorsal elevation

Background and objective: Catheterization of the internal jugular vein is traditionally performed with the patient lying flat or in the Trendelenburg position. This puts patients with elevated intracranial pressure at risk of cerebral herniation. The objective of this study was to assess the safety of real-time ultrasound-guided catheterization of the internal jugular vein in ventilated patients with the patient positioned in a 30° head-up position. Methods: This prospective, single-centre case series was performed in a 12-bed multi-disciplinary adult intensive care unit (ICU) in a 1500-bed university hospital. The cohort consisted of 64 ventilated ICU patients (14 female, 50 male) with a median age of 52 yr (range 18-85 yr), needing central venous cannulation for insertion of a central venous, haemodialysis or pulmonary artery catheter. The majority of patients presented with risk factors for a difficult cannulation. Catheterization was performed using real-time ultrasound guidance with all patients positioned in 30° dorsal elevation. Results: Ultrasound-guided cannulation of the internal jugular vein was successful in all patients. There was no evidence of air embolism. Despite a high incidence of anomalous anatomy (39%) no injury to the carotid artery occurred. Central venous access was established in less than 1 min in 75% of patients. Conclusion: Ultrasound-guided cannulation of the internal jugular vein in ventilated ICU patients can be performed successfully with the patient positioned in 30° dorsal elevation. Potentially deleterious position changes can thus be avoided in high-risk patients.

[1]  N. Roewer,et al.  Ultraschallgesteuerte zentralvenöse Punktion bei neuropädiatrischen Patienten unter Vermeidung von potentiell hirndrucksteigernden Maßnahmen , 2003, Der Anaesthesist.

[2]  T. Mills,et al.  Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[3]  S. Keenan,et al.  Use of ultrasound to place central lines. , 2002, Journal of critical care.

[4]  R. Kaplan,et al.  The Effects of the Simulated Valsalva Maneuver, Liver Compression, and/or Trendelenburg Position on the Cross-Sectional Area of the Internal Jugular Vein in Infants and Young Children , 2002 .

[5]  T. Vesely.  Air embolism during insertion of central venous catheters. , 2001, Journal of vascular and interventional radiology : JVIR.

[6]  P. Brass,et al.  Zentralvenöse Punktion - nur noch mit Ultraschall? , 2001 .

[7]  P. Aadahl,et al.  [Ultrasound guidance for placement of central venous catheters]. , 1999, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[8]  X. Wu,et al.  High incidence of intravenous thrombi after short-term central venous catheterization of the internal jugular vein. , 1999, Journal of clinical anesthesia.

[9]  M. Blanda,et al.  Ultrasound-assisted internal jugular vein catheterization in the ED. , 1998, The American journal of emergency medicine.

[10]  J. Saliken,et al.  US-guided puncture of the internal jugular vein: complications and anatomic considerations. , 1998, Journal of vascular and interventional radiology : JVIR.

[11]  M Gebel,et al.  A sonographically guided technique for central venous access. , 1997, AJR. American journal of roentgenology.

[12]  M. Safar,et al.  Improvement of internal jugular vein cannulation using an ultrasound-guided technique , 1997, Intensive Care Medicine.

[13]  A G Randolph,et al.  Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. , 1996, Critical care medicine.

[14]  Christopher A. Troianos,et al.  Internal Jugular Vein and Carotid Artery Anatomic Relation as Determined by Ultrasonography , 1996, Anesthesiology.

[15]  N. Gravenstein,et al.  Head Rotation During Internal Jugular Vein Cannulation and the Risk of Carotid Artery Puncture , 1996, Anesthesia and analgesia.

[16]  D. Scott,et al.  The effect of position and different manoeuvres on internal jugular vein diameter size , 1994, Acta anaesthesiologica Scandinavica.

[17]  M. Suhonen,et al.  Ultrasound‐facilitated central venous cannulation , 1992, Critical care medicine.

[18]  M. Bazaral,et al.  Ultrasonographic anatomy of the internal jugular vein relevant to percutaneous cannulation , 1981, Critical care medicine.