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Title: Role of ultrasound guidance during puncture of internal jugular vein in patients of coronary care unit

Andrzej Gackowski, Anton Chrustowicz, Ewa Konduracka, Nader El Massri
Original articles
Polish Journal of Cardiology
Start page:
Final page:
venipuncture, ultrasonography, internal jugular vein, safety, complications

Introduction: Puncture of internal jugular vein (IJV) is frequently performed procedure. It can be difficult, particularly in short and obese patients. Multiple puncture attempts cause increased risk of severe bleeding complications, particularly in patients treated with anticoagulants. Aim of study: Assessment of usefulness of ultrasound (US) - guided puncture of IJV. Material and methods: Study was performed in 45 patients (23 male, 22 female, aged 60.8±11 years). Decision about US use was random and depen- ded on availability of US machine at the moment of puncture. Routine puncture based on anatomical landmarks was performed in 22 patients (ANAT group). In 23 patients US guidance was used with linear 7 MHz probe placed in a sterile glove and positioned below the planned puncture site, perpendicular to the needle (US group). Puncture site and needle direction was optimized and the needle was traced until the moment of venipuncture. Results: In 5 out of 23 patients of US group (21%) collapse of the IJV due to hypovolemia was detected. Better vein filling was achieved by in vitro fluid administration and using Trendelenburg position. IJV puncture during first attempt was achieved in 20 US group patients (87%) and in ANAT group patients (27.3%; p=0.01), number of neck puncture attempts was significantly lower in US group (1.3±0.6 vs 2.0±0.9; p=0.002). Puncture of both anterior and posterior vein walls was more frequent in ANAT group (40% vs 13% of patients; p=0.03). Puncture of common carotid artery took place in 2 ANAT group patients and in none of the US group patients (p=0.3). Local hematoma was detected in 2% US group patients and in 5% of ANAT group patients (p=0.5). The puncture was effective in all US group patients and in 21 ANAT group patients (95%). In 1 ANAT group patient, after four puncture attempts local hematoma developed due to accidental arterial puncture. The procedure was terminated and after US use effective venipuncture on the other side of the neck was done. The reason of the difficulties was atypical anatomy - IJV was located antero-medially to the carotid artery. Conclusions: 1. Brief US examination can detect collapse of IJV due to hypovolemia or atypical anatomy. 2. US guidance facilitates the procedure, decreasing the number of neck puncture attempts. Therefore, the technique should be particularly considered in patients with difficult neck anatomy or treated with anticoagulants.