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Posterior triangle approach for lateral in-plane technique during hemodialysis catheter insertion via the internal jugular vein.

Song D, Yun S, Cho S - Ann Surg Treat Res (2015)

Bottom Line: Some techniques have been introduced for ultrasound-guided central venous catheterization.Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access.Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
A recent widespread concept is that ultrasound-guided central venous catheter insertion is a mandatory method. Some techniques have been introduced for ultrasound-guided central venous catheterization. Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access. Therefore, we used this technique for the insertion of a large-bore cuffed tunneled dual-lumen catheter for hemodialysis. Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle. Using this approach, we can reduce the possible complications of pinching and kinking of the catheter.

No MeSH data available.


Related in: MedlinePlus

(A) Ultrasound-guided needle puncture image using the short axis lateral in-plane technique; Image shows the puncture needle, internal jugular vein (IJV), carotid artery (CA), and the sternocleidomastoid (SCM) muscle. The tip of the needle inside the IJV along with the entire course of the needle is identified. The needle is passed from the posterior triangle, through the nonmuscular area under the SCM muscle. The course of the needle is angled at about 30° to a horizontal line. (B) CT image using the short axis lateral in-plane technique. Needle drives a horizontal line from the posterior triangle. The trajectory of the needle from the Sedillot's triangle forms an angle of about 30°-45° against the horizontal line. (C) The course of needle from Sedillot's triangle has two mixed curvatures; rotation and downward. (D) The immediate C-arm fluoroscope image confirmed that the catheter was not kinking. The catheter's midline was kept in the middle of the catheter throughout the full length.
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Figure 1: (A) Ultrasound-guided needle puncture image using the short axis lateral in-plane technique; Image shows the puncture needle, internal jugular vein (IJV), carotid artery (CA), and the sternocleidomastoid (SCM) muscle. The tip of the needle inside the IJV along with the entire course of the needle is identified. The needle is passed from the posterior triangle, through the nonmuscular area under the SCM muscle. The course of the needle is angled at about 30° to a horizontal line. (B) CT image using the short axis lateral in-plane technique. Needle drives a horizontal line from the posterior triangle. The trajectory of the needle from the Sedillot's triangle forms an angle of about 30°-45° against the horizontal line. (C) The course of needle from Sedillot's triangle has two mixed curvatures; rotation and downward. (D) The immediate C-arm fluoroscope image confirmed that the catheter was not kinking. The catheter's midline was kept in the middle of the catheter throughout the full length.

Mentions: In the supine position under local anesthesia, the head was turned slightly to the left side and the sternocleidomastoid (SCM) muscle popped out of the neck. For ultrasound-guided puncture, the Doppler ultrasound probe was wrapped in a sterile cover. The right IJV and carotid artery were identified using Doppler ultrasound. The diameter of the IJV was 14 mm, being anterolateral in relation to the carotid artery. The entry site of the needle was lateral to the lateral margin of the SCM muscle in the posterior triangle and it was directed towards the IJV at an angle parallel to the horizontal plane (Fig. 1A, B). Cannulation of the IJV was achieved on the first attempt of puncture. The vein was entered within 5- to 7-cm depth of the needle. Retraction of the syringe plunger produced a flush of dark red blood when the IJV was entered. After puncture of the superior lateral wall of the IJV, a J-tip steel guidewire was passed through the needle into the vein. The skin over the guidewire exit site was minimally incised to accommodate at least the diameter of the catheter. An incision was made on the planned catheter exit site below the midclavicle. The catheter (HEMO-FLOW, Medcomp Components Inc., Harleysville, PA, USA) was advanced subcutaneously from the catheter exit site to the guidewire exit site. Care was taken to ensure that the tunnel provides a gentle curve to the catheter from the catheter exit site to the guidewire exit site. After dilating the vein, the dilator/sheath combination was placed over the wire. The dilator was removed, the catheter was advanced through the sheath, and the sheath was peeled away. The position of the tip of the catheter was checked. There were no immediate postprocedural complications. The time to catheter placement was 15 minutes.


Posterior triangle approach for lateral in-plane technique during hemodialysis catheter insertion via the internal jugular vein.

Song D, Yun S, Cho S - Ann Surg Treat Res (2015)

(A) Ultrasound-guided needle puncture image using the short axis lateral in-plane technique; Image shows the puncture needle, internal jugular vein (IJV), carotid artery (CA), and the sternocleidomastoid (SCM) muscle. The tip of the needle inside the IJV along with the entire course of the needle is identified. The needle is passed from the posterior triangle, through the nonmuscular area under the SCM muscle. The course of the needle is angled at about 30° to a horizontal line. (B) CT image using the short axis lateral in-plane technique. Needle drives a horizontal line from the posterior triangle. The trajectory of the needle from the Sedillot's triangle forms an angle of about 30°-45° against the horizontal line. (C) The course of needle from Sedillot's triangle has two mixed curvatures; rotation and downward. (D) The immediate C-arm fluoroscope image confirmed that the catheter was not kinking. The catheter's midline was kept in the middle of the catheter throughout the full length.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325648&req=5

Figure 1: (A) Ultrasound-guided needle puncture image using the short axis lateral in-plane technique; Image shows the puncture needle, internal jugular vein (IJV), carotid artery (CA), and the sternocleidomastoid (SCM) muscle. The tip of the needle inside the IJV along with the entire course of the needle is identified. The needle is passed from the posterior triangle, through the nonmuscular area under the SCM muscle. The course of the needle is angled at about 30° to a horizontal line. (B) CT image using the short axis lateral in-plane technique. Needle drives a horizontal line from the posterior triangle. The trajectory of the needle from the Sedillot's triangle forms an angle of about 30°-45° against the horizontal line. (C) The course of needle from Sedillot's triangle has two mixed curvatures; rotation and downward. (D) The immediate C-arm fluoroscope image confirmed that the catheter was not kinking. The catheter's midline was kept in the middle of the catheter throughout the full length.
Mentions: In the supine position under local anesthesia, the head was turned slightly to the left side and the sternocleidomastoid (SCM) muscle popped out of the neck. For ultrasound-guided puncture, the Doppler ultrasound probe was wrapped in a sterile cover. The right IJV and carotid artery were identified using Doppler ultrasound. The diameter of the IJV was 14 mm, being anterolateral in relation to the carotid artery. The entry site of the needle was lateral to the lateral margin of the SCM muscle in the posterior triangle and it was directed towards the IJV at an angle parallel to the horizontal plane (Fig. 1A, B). Cannulation of the IJV was achieved on the first attempt of puncture. The vein was entered within 5- to 7-cm depth of the needle. Retraction of the syringe plunger produced a flush of dark red blood when the IJV was entered. After puncture of the superior lateral wall of the IJV, a J-tip steel guidewire was passed through the needle into the vein. The skin over the guidewire exit site was minimally incised to accommodate at least the diameter of the catheter. An incision was made on the planned catheter exit site below the midclavicle. The catheter (HEMO-FLOW, Medcomp Components Inc., Harleysville, PA, USA) was advanced subcutaneously from the catheter exit site to the guidewire exit site. Care was taken to ensure that the tunnel provides a gentle curve to the catheter from the catheter exit site to the guidewire exit site. After dilating the vein, the dilator/sheath combination was placed over the wire. The dilator was removed, the catheter was advanced through the sheath, and the sheath was peeled away. The position of the tip of the catheter was checked. There were no immediate postprocedural complications. The time to catheter placement was 15 minutes.

Bottom Line: Some techniques have been introduced for ultrasound-guided central venous catheterization.Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access.Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
A recent widespread concept is that ultrasound-guided central venous catheter insertion is a mandatory method. Some techniques have been introduced for ultrasound-guided central venous catheterization. Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access. Therefore, we used this technique for the insertion of a large-bore cuffed tunneled dual-lumen catheter for hemodialysis. Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle. Using this approach, we can reduce the possible complications of pinching and kinking of the catheter.

No MeSH data available.


Related in: MedlinePlus