Internal jugular vein cannulation: How much safety can we offer?
Keywords:
Ultrasonography, Catheters, Patient safety, Catheterization, Central venous Anesthesia
Abstract
Introduction: Central venous catheterization, performed by the anatomical landmark technique, has a mechanical complication rate between 5% and 19%. This technique has been modified and new approaches have been implemented aiming to improve patient safety. With the introduction of ultrasonography in the clinical practice, and recently in central venous catheter insertion, the rate of complications has dropped over time.
Objective: To measure the clinical application of the algorithm "Successful ultrasound-guided internal jugular vein cannulation".
Methods: A descriptive, prospective, case series study. Patients over 18 years of age were selected, and the informed consent documentation was filled out appropriately. Patients with masses, anatomical abnormalities, insertion site infections and coagulopathy (International Normalized Ratio [INR] ≥ 2.0, platelet count ≤50.000) were excluded. Central venous cannulation was performed under ultrasound guidance in accordance with safety of the Fundación Santa Fe de Bogotá University Hospital (HUFSFB). Adjustment and validation of the algorithm was done according to an expert consensus in our department. A descriptive univariate analysis was conducted, and efficacy was determined on the basis of the number of attempts to achieve successful venous cannulation, and the incidence of complications.
Results: This series included 38 patients with a mean age of 62 years. In 97.4% of the cases, successful venous cannulation was achieved on the first attempt. Guidewire displacement was observed in one case, requiring a second attempt. The posterior jugular vein wall was punctured in two patients (5.2%), with no associated arterial vascular injury or pneumoth-orax.
Conclusions: This algorithm resulted in a high rate of successful first attempts and the prevention of potential complications, improving operational standards and healthcare quality for the patients.
References
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17. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Saranteas T. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med. 2011;39:1607-12.
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27. Chittoodan S, Breen D, O'Donnell B, Iohom G. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason. 2011;13:21-5.
28. Blaivas M, Brannam L, Fernandez E. Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimat model. Acad Emerg Med. 2003;10:1307-11.
29. Augoustides JG, Horak J, Ochroch AE, Vernick WJ, Gambone AJ, Weiner J. A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department. J Cardiothorac Vasc Anesth. 2005;19:310-5.
30. Rabindranath KS, Kumar E, Rabindranath KS, Kumar E, Shail R, Vaux E. Use of real-time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis. 2011;58:964-70.
31. Gillman LM, Blaivas M, Lord J, Al-Kadi A, Kirkpatrick AW. Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation. Scand J Trauma Resusc Emerg Med. 2010;18:39.
32. Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 2011;14:217-24.
33. Lee JH, Bahk JH, Ryu HG, Jung CW, Jeon Y.Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance. Br J Anaesth. 2009;102:662-6. Epub 2009 March 26.
34. Jeon Y, Ryu HG, Yoon SZ, Kim JH, Bahk JH. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anaesth. 2006;53:978-83.
35. Girard TD, Schectman JM. Ultrasound guidance during central venous catheterization: a survey of use by house staff physicians. J Crit Care. 2005;20:224-9.
36. Raffán F, Guerrero C. La canalización de la vena yugular interna guiada por ultrasonografía en pacientes sometidos a trasplante hepático. Rev Colomb Anestesiol. 2001;29:295-300.
37. Dilisio R, Mittnacht AJ. The "medial-oblique" approach to ultrasound-guided central venous cannulation-maximize the view, minimize the risk. J Cardiothorac Vas Anesth. 2012;26:982-4.
2. English ICW, Frew RM, Pigott JFG, Zaky M. Percutaneous cannulation of the internal jugular vein. Thorax. 1969;24:496-7.
3. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24:1291-318.
4. Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, Domino KB, et al. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012;116:539-73.
5. Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverly C, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327:361.
6. Keenan SP. Use of ultrasound to place central lines. J Crit Care. 2002;17:126-37.
7. Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24:2053-8.
8. Feller-Kopman D. Ultrasound-guided internal jugular access: a proposed standardized approach and implications for training and practice. Chest. 2007;132:302-9.
9. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123-33.
10. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med. 1994;331:1735-8.
11. Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204:681-96.
12. Ortega R, Song M, Hansen CJ, Barash P. Videos in clinical medicine. Ultrasound-guided internal jugular vein cannulation. N Engl J Med. 2010;362:e57.
13. Raffán F, Garcia MT, Celis E, Chaves A, Ramirez F, Diaz J. Algoritmo de práctica clínica basado en la evidencia para el uso de ultrasonido en la colocación de cateteres venosos centrales. Rev Colomb Anestesiol. 2005;33:51-8.
14. Rothschild JM. Evidence report/technology assessment number 43: making health care. Safer: a critical analysis of patient safety practices. US Department of Health and Human Services Publication 01-E058; 2001.
15. National Institute for Clinical Excellence: Guidance on the Use of Ultrasound Locating Devices for Central Venous Catheters (NICE technology appraisal, No. 49). London: NICE; 2002.
16. Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne D. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009;37:2697-701.
17. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Saranteas T. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med. 2011;39:1607-12.
18. Troianos CA, Jobes DR, Ellison N. Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg. 1991;72:823-6.
19. Parry G. Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter. Can J Anaesth. 2004;51:379-81.
20. Troianos CA, Kuwik RJ, Pasqual JR, Li AJ, Odasso DP. Internal jugular vein and carotid artery anatomi relation as determined by ultrasonography. Anesthesiology. 1996;85:43-8.
21. Sulek CA, Gravenstein N, Blackshear R, Weiss L. Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg. 1996;82:125-8.
22. Lieberman JA, Williams KA, Rosenberg AL. Optimal head rotation for internal jugular vein cannulation when relying on external landmarks. Anesth Analg. 2004;99:982-8.
23. Wang R, Snoey ER, Clements RC, Hern HG, Price D. Effect of head rotation on vascular anatomy of the neck: an ultrasound study. J Emerg Med. 2006;31:283-6.
24. Scháberle W. Ultrasonography in Vascular Diagnosis. Chap. 1. Fundamental Principles; 2011. p. 1-27.
25. Turba UC, Uflacker R, Hannegan C, Selby JB. Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures. Cardiovasc Interv Radiol. 2005;28:303-6.
26. Blaiva M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med. 2009;37:2345-9.
27. Chittoodan S, Breen D, O'Donnell B, Iohom G. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason. 2011;13:21-5.
28. Blaivas M, Brannam L, Fernandez E. Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimat model. Acad Emerg Med. 2003;10:1307-11.
29. Augoustides JG, Horak J, Ochroch AE, Vernick WJ, Gambone AJ, Weiner J. A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department. J Cardiothorac Vasc Anesth. 2005;19:310-5.
30. Rabindranath KS, Kumar E, Rabindranath KS, Kumar E, Shail R, Vaux E. Use of real-time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis. 2011;58:964-70.
31. Gillman LM, Blaivas M, Lord J, Al-Kadi A, Kirkpatrick AW. Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation. Scand J Trauma Resusc Emerg Med. 2010;18:39.
32. Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 2011;14:217-24.
33. Lee JH, Bahk JH, Ryu HG, Jung CW, Jeon Y.Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance. Br J Anaesth. 2009;102:662-6. Epub 2009 March 26.
34. Jeon Y, Ryu HG, Yoon SZ, Kim JH, Bahk JH. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anaesth. 2006;53:978-83.
35. Girard TD, Schectman JM. Ultrasound guidance during central venous catheterization: a survey of use by house staff physicians. J Crit Care. 2005;20:224-9.
36. Raffán F, Guerrero C. La canalización de la vena yugular interna guiada por ultrasonografía en pacientes sometidos a trasplante hepático. Rev Colomb Anestesiol. 2001;29:295-300.
37. Dilisio R, Mittnacht AJ. The "medial-oblique" approach to ultrasound-guided central venous cannulation-maximize the view, minimize the risk. J Cardiothorac Vas Anesth. 2012;26:982-4.
How to Cite
1.
Amaya Zuñiga WF, Raffán Sanabria F, Niño de Mejía C, Hermida E, Alvarado Sánchez J, Solórzano MC, et al. Internal jugular vein cannulation: How much safety can we offer?. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 19];43(1):76-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/487
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2015-01-01
How to Cite
1.
Amaya Zuñiga WF, Raffán Sanabria F, Niño de Mejía C, Hermida E, Alvarado Sánchez J, Solórzano MC, et al. Internal jugular vein cannulation: How much safety can we offer?. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 19];43(1):76-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/487
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