Percutaneous Ultrasound-guided Central Venous Catheters: The Lateral In-plane Technique for Internal Jugular Vein Access

Arterial misplacement of central venous catheters can often be avoided with the use of real-time ultrasound-guided procedural competency. However, misplacement can still occur and is more likely to occur when the internal jugular vein is located directly above the common carotid injury. The resultant injury to the common carotid artery occurs through the posterior wall of the internal jugular vein. Arterial injury may also occur when the subclavian vein is attempted in a non-ultrasound-guided fashion. Optimal management requires a coordinated evaluation of the catheter misplacement by Interventional Radiology and Vascular Surgery to ensure maximum patient safety during catheter removal. This article reviews the literature around this topic and provides a summary of the best approach to safely remove the misplaced catheter. Resume Le mauvais positionnement artériel des cathéters veineux centraux peut souvent être évité grâce à l'utilisation de compétences procédurales guidées par ultrasons en temps réel. Cependant, un mauvais positionnement peut toujours se produire et est plus susceptible de se produire lorsque la veine jugulaire interne est située directement au-dessus de la lésion carotidienne commune. La lésion de l'artère carotide commune qui en résulte se produit à travers la paroi postérieure de la veine jugulaire interne. Une lésion artérielle peut également se produire lorsque la veine sous-clavière n'est pas guidée par un ultrason. Une gestion optimale nécessite une évaluation coordonnée du mauvais positionnement du cathéter par la radiologie interventionnelle et la chirurgie vasculaire afin de garantir une sécurité maximale au patient lors du retrait du cathéter. Cet article passe en revue la littérature sur ce sujet et fournit un résumé de la meilleure approche pour retirer en toute sécurité le cathéter mal placé.

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Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2019.12.004 ◽

2020 ◽

Vol 55 (9) ◽

pp. 1920-1924 ◽

Cited By ~ 1

Author(s):

Fernando Montes-Tapia ◽

Karla Hernández-Trejo ◽

Fernando García-Rodríguez ◽

Julio Jaime-Reyes ◽

Consuelo Treviño-Garza ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Central Venous Catheters ◽

Ultrasound Guided ◽

Central Venous ◽

Optimal Depth

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Central venous catheter care for the patients with cancer: ultrasound-guided insertion should be strongly recommended for internal jugular vein catheterization

Annals of Oncology ◽

10.1093/annonc/mdt387 ◽

2013 ◽

Vol 24 (11) ◽

pp. 2928-2929 ◽

Cited By ~ 5

Author(s):

L. Cavanna ◽

G. Civardi ◽

P. Mordenti ◽

D. Vallisa ◽

R. Bertè ◽

...

Keyword(s):

Central Venous Catheter ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Ultrasound Guided ◽

Central Venous ◽

Patients With Cancer ◽

Internal Jugular Vein Catheterization ◽

Vein Catheterization ◽

Catheter Care

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A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

Birat Journal of Health Sciences ◽

10.3126/bjhs.v2i3.18943 ◽

2018 ◽

Vol 2 (3) ◽

pp. 277-281

Author(s):

Lalit Kumar Rajbanshi ◽

Sambhu Bahadur Karki ◽

Batsalya Arjyal

Keyword(s):

Real Time ◽

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Anatomical Landmark ◽

Ultrasound Guided ◽

Central Venous ◽

Catheter Tip ◽

Landmark Technique

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

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Ultrasound guided versus land mark technique for internal jugular central venous catheterization in cardiac surgical patients- a randomized trial

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v3i1.14636 ◽

2016 ◽

Vol 3 (1) ◽

pp. 18-21 ◽

Cited By ~ 2

Author(s):

Santosh Sharma Parajuli ◽

Jeju Nath Pokharel

Keyword(s):

Internal Jugular Vein ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Venous Cannulation ◽

Ultrasound Guided ◽

Central Venous ◽

Successful Cannulation ◽

Venous Catheterization ◽

Complications Rate ◽

Landmark Technique

Background: Catheterization of internal jugular vein can be achieved by either anatomical landmark technique or the ultrasound guided technique. The objective of our study is to find out if ultrasound guided technique could be beneficial in placing central venous catheters by improving the success rate by reducing the number of attempts, decreasing the access time and decreasing the complications rate in comparison to the landmark technique.Methods: Fifty patients scheduled for cardiac surgery requiring central venous cannulation of the right internal jugular vein were divided into two groups: ultrasound guided group ‘U’ and the landmark group ‘L’, each consisting of 25 patients with age more than 15 years. The outcomes were compared in terms of success rate, time taken for successful cannulation and rate of complications.Results: The two groups were comparable in terms of age, weight, heart rate and blood pressure. The mean number of attempts for successful cannulation was 1.08±0.277 and 1.40±0.764 (p=0.055), the time taken in seconds for successful cannulation was 108.56±27.822 and 132.08±72.529 (p=0.137) and the overall complication rate was 0% (0 out of 25) and 32% (8 out of 25) (p=0.02) in the ultrasound guided and the landmark technique group respectively.Conclusion: Ultrasound guided central venous catheterization of internal jugular vein is comparable to the landmark technique in terms of number of attempts and the time required for successful cannulation. Ultrasound guided technique is much safer than the landmark technique to reduce the overall complications rate during central venous cannulation.

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