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Absent internal jugular vein: Another case for ultrasound guided vascular access.

Rewari V, Chandran R, Ramachandran R, Trikha A - Indian J Crit Care Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
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The ICU resident placed a central venous catheter (CVC) in left IJV as he was unable to visualize the right IJV on ultrasound... On the 10 ICU day, the CVC insertion site was found to be inflamed, and it was decided to resite the catheter on the right side... Landmark guided central venous cannulation is based on the premise of normal anatomy of the vein and its adjoining structures... In a study on long-term hemodialysis patients, the incidence of significant US findings such as total occlusion, nonocclusive thrombus and stenosis was seen to be as high as 35%... Agenesis or hypoplasia of the central veins though rare is another probable cause of failed cannulation in patients where US guidance is not used... Denys and Uretsky studied 200 patients undergoing IJV cannulation under US guidance and found that in 2.5% of the patients, the IJV was not visualized... Absence of the right sided IJV has also been reported in a 12-year-old boy during US evaluation prior to attempted cannulation... In developing countries, landmark based technique is commonly practiced as an US machine may not be available in all centers... Central venous cannulation using the landmark technique in a patient with absent IJV may be associated with a higher incidence of complications such as arterial puncture and pneumothorax... This case reiterates the use of US guided vascular access to prevent complications, which can arise due to the absence of a vein or other venous anomalies... In addition, it has been shown that US-guided CVC placement technique is easy to learn even by novices and any previous CVC and/or US experience allows a better technique and shorter total time to placement... It would be a good general practice to use US for both assessment of anatomy prior to venipuncture and real-time visualization during insertion of CVC to increase the success rate and prevent complications.

No MeSH data available.


Related in: MedlinePlus

Ultrasound image of the right side of the neck showing absence of internal jugular vein. CA: Carotid artery
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Figure 1: Ultrasound image of the right side of the neck showing absence of internal jugular vein. CA: Carotid artery

Mentions: The right side of the neck was examined carefully, and no evidence of scarring suggesting previous surgery or cannulation was seen. The ICU consultant scanned the right side of the neck carefully using a portable ultrasound (US) machine (IMAGIC Agile, Kontron Medical, WA, USA) with a linear, high frequency transducer (7.5–12 MHz). Care was taken to apply minimal pressure on the probe to prevent collapse of the IJV. Imaging showed a single pulsatile vessel, which was non compressible suggestive of the carotid artery with no evidence of the IJV [Figure 1]. Doppler confirmed the characteristic pulsatile blood flow in the carotid artery. The 2D US imaging on the left side showed normal anatomy with good size IJV [Figure 2]. Subsequently, the CVC was placed in the right axillary vein under real-time US guidance in a single attempt.


Absent internal jugular vein: Another case for ultrasound guided vascular access.

Rewari V, Chandran R, Ramachandran R, Trikha A - Indian J Crit Care Med (2015)

Ultrasound image of the right side of the neck showing absence of internal jugular vein. CA: Carotid artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296414&req=5

Figure 1: Ultrasound image of the right side of the neck showing absence of internal jugular vein. CA: Carotid artery
Mentions: The right side of the neck was examined carefully, and no evidence of scarring suggesting previous surgery or cannulation was seen. The ICU consultant scanned the right side of the neck carefully using a portable ultrasound (US) machine (IMAGIC Agile, Kontron Medical, WA, USA) with a linear, high frequency transducer (7.5–12 MHz). Care was taken to apply minimal pressure on the probe to prevent collapse of the IJV. Imaging showed a single pulsatile vessel, which was non compressible suggestive of the carotid artery with no evidence of the IJV [Figure 1]. Doppler confirmed the characteristic pulsatile blood flow in the carotid artery. The 2D US imaging on the left side showed normal anatomy with good size IJV [Figure 2]. Subsequently, the CVC was placed in the right axillary vein under real-time US guidance in a single attempt.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The ICU resident placed a central venous catheter (CVC) in left IJV as he was unable to visualize the right IJV on ultrasound... On the 10 ICU day, the CVC insertion site was found to be inflamed, and it was decided to resite the catheter on the right side... Landmark guided central venous cannulation is based on the premise of normal anatomy of the vein and its adjoining structures... In a study on long-term hemodialysis patients, the incidence of significant US findings such as total occlusion, nonocclusive thrombus and stenosis was seen to be as high as 35%... Agenesis or hypoplasia of the central veins though rare is another probable cause of failed cannulation in patients where US guidance is not used... Denys and Uretsky studied 200 patients undergoing IJV cannulation under US guidance and found that in 2.5% of the patients, the IJV was not visualized... Absence of the right sided IJV has also been reported in a 12-year-old boy during US evaluation prior to attempted cannulation... In developing countries, landmark based technique is commonly practiced as an US machine may not be available in all centers... Central venous cannulation using the landmark technique in a patient with absent IJV may be associated with a higher incidence of complications such as arterial puncture and pneumothorax... This case reiterates the use of US guided vascular access to prevent complications, which can arise due to the absence of a vein or other venous anomalies... In addition, it has been shown that US-guided CVC placement technique is easy to learn even by novices and any previous CVC and/or US experience allows a better technique and shorter total time to placement... It would be a good general practice to use US for both assessment of anatomy prior to venipuncture and real-time visualization during insertion of CVC to increase the success rate and prevent complications.

No MeSH data available.


Related in: MedlinePlus