Skip to main content

Internal jugular vein catheterization...Bevel Down

Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization.

Crit Care Med. 2012 Feb;40(2):491-4.

OBJECTIVE: Artery puncture and hematoma formation are the most common immediate complications during internal jugular vein catheterization. This study was performed to assess whether the bevel-down approach of the puncture needle decreases the incidence of posterior venous wall damage and hematoma formation during internal jugular vein catheterization.

PATIENTS: Three hundred thirty-eight patients for scheduled for thoracic surgery requiring central venous catheterization in the right internal jugular vein.

INTERVENTIONS:

 Patients requiring internal jugular vein catheterization were enrolled and randomized to either the bevel-down group (n = 169) or the bevel-up group (n = 169). All patients were placed in the Trendelenburg position with the head turned to the left. After identifying the right internal jugular vein with ultrasound imaging, a double-lumen central venous catheter was inserted using the modified Seldinger technique. Venous entry of the needle was recognized by return of venous blood during needle advance or withdrawal. The internal jugular vein was assessed cross-sectionally and longitudinally after catheterization to identify any complications.
 A p value of <.05 was considered to be statistically significant.

MEASUREMENTS AND MAIN RESULTS:

There was no difference in the incidence of the puncture-on-withdrawal between the two groups (37 of 169 in the bevel-down group and 25 of 169 in the bevel-up group). However, the incidence of posterior hematoma formation was lower in the bevel-down group (six of 169 vs. 17 of 169, p = .031). Additionally, there was less incidence of the posterior hematoma formation associated with puncture-on-withdrawal in the bevel-down group (six of 37 vs. 11 of 25, p = .034).

CONCLUSIONS:

The bevel-down approach of the right internal jugular vein may decrease the incidence of posterior venous wall damage and hematoma formation compared with the bevel-up approach, which implicates a reduced probability of carotid artery puncture with the bevel-down approach during internal jugular vein catheterization.

Labels

Labels:

Comments

Post a Comment

Popular posts from this blog

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...
5 comments
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more

Epidural catheter tests...not only the test dose

Siphon test The catheter is held upright and a fluid level sought. If the catheter is then elevated, the fluid level should fall (see inset) as the fluid siphons in to the epidural space, which is usually under negative pressure compared with atmospheric. If the fluid column continues to rise, this may suggest subarachnoid placement. The siphon test can be reassuring, but is not mandatory. Aspiration  This should be considered mandatory. The Luer connector is attached to the catheter and a syringe is used to apply negative pressure. Free and continued aspiration of clear fluid can indicate subarachnoid placement of the catheter. However, if saline has been used for loss of resistance, it is not unusual for a small amount of this to be aspirated. If there is doubt, the aspirated fluid can be tested for glucose (cerebrospinal fluid will generally test positive) or mixed with thiopentone (cerebrospinal fluid forms a precipitate). If blood is freely and continuously aspirated, this sug...
Post a Comment
Read more