Original ContributionInternal jugular veins must be measured before catheterization
Introduction
Internal jugular vein (IJV) catheterization is an essential and commonly performed procedure in the management of critically ill patients. It allows for invasive hemodynamic monitoring with pulmonary artery catheter, total parenteral nutrition, drug delivery, temporary cardiac pacing, venous blood sampling, and renal replacement therapy. However, procedure failure and complications after catheter placement are not rare [1], [2]. These may be the result of the small cross-sectional area (CSA) of IJVs, which are difficult, sometimes even impossible to palpate transcutaneously and insert a catheter. Small vessels are also more prone to endothelial damage during cannulation and to the following thrombosis than large ones [3]. Unfortunately, there is a shortage of data about morphologic parameters of IJVs in healthy subjects.
The aim of the study was to evaluate the CSA of IJVs in healthy subjects.
Section snippets
Materials and methods
The examined group consisted of 185 healthy White subjects: 101 women and 84 men, aged 18-89 years (mean 46.2 ± 20.9). Subjects for the study were volunteers recruited from students of the medical center, hospital staff, and their relatives. The study was approved by the Commission of Bioethics at Bialystok Medical University, and each subject gave informed consent. All ultrasonography examinations were performed in gray-scale by radiologist with 6 years' experience in ultrasonography (DC)
Results
The CSA of the IJVs varied widely in the entire examined group as well as in the separate sexes (Table). There were no statistically significant differences between sex groups. The CSA of the IJV on the right side was significantly greater than on the left side. The IJV on the right side was also more often classified as the “dominant” vessel (n = 36; 54%) compared with the left side (n = 31; 46%). The asymmetry between vessels on both sides differed by up to 850% when comparing right-to-left
Discussion
The CSA of IJVs in healthy subjects in the supine position is significantly greater on the right side than on the left, with the right being more often “dominant.” Similar trends were found by other authors. Lobato et al [4] reported greater CSAs of right IJVs in 80% and significantly smaller CSAs (defined as a CSA < 50% compared with the opposite vessel) of left IJVs in 34% of healthy subjects. Lichtenstein et al [5] also found that right IJVs were more commonly “dominant” than left IJVs in a
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2016, Journal of Clinical AnesthesiaCitation Excerpt :In addition, the RIJV was less likely to be in an anterior position to its corresponding CA in comparison with the LIJV. Previous investigations have examined neck anatomy relevant to IJV (IJV) cannulation in supine healthy patients with neutral head position [1,17–23]. Our study found that the RIJV was dominant in 72% of patients and had a larger diameter and CSA compared with the LIJV (Table 2).
Internal jugular veins must be measured before catheterisation
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