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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) Short axis, Out-of-Plane (Vertical) approach. (B) Long axis, in-plane approach. (C) Long axis, lateral out-of-plane approach. (D) Short axis, lateral in-plane technique; it allows simultaneous view of the full length of the needle, the internal jugular vein, carotid artery, and adjacent tissue. (E) Puncture needle was inserted at the posterior triangle, which consisted of posterior margin of the sternocleidomastoid muscle, anterior margin of the trapezius muscle, and clavicle. (F) A completely inserted catheter had a smooth curvature over the clavicle while maintaining its horizontal line, and did not show any kinking.
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Figure 2: (A) Short axis, Out-of-Plane (Vertical) approach. (B) Long axis, in-plane approach. (C) Long axis, lateral out-of-plane approach. (D) Short axis, lateral in-plane technique; it allows simultaneous view of the full length of the needle, the internal jugular vein, carotid artery, and adjacent tissue. (E) Puncture needle was inserted at the posterior triangle, which consisted of posterior margin of the sternocleidomastoid muscle, anterior margin of the trapezius muscle, and clavicle. (F) A completely inserted catheter had a smooth curvature over the clavicle while maintaining its horizontal line, and did not show any kinking.

Mentions: In the "short-axis out-of-plane" view, the operators have a very limited view of the needle tip and an adjustment of the probe is needed to have the needle tip aligned with the ultrasound beam. The operators have to coordinate the needle and ultrasound probe movements (Fig. 2A). In the "long-axis in-plane" view, the whole course of the IJV can be seen with the in-plane technique. However, surrounding structures (carotid artery, thyroid, lymph nodes) cannot be visualized. The needle insertion level is higher than that in the other technique as long as the probe length. Although the probe is positioned on the patient's neck with its caudal edge in contact with the clavicle, the needle would be inserted from the cranial edge of the ultrasound probe, away from the clavicle (Fig. 2B). In the "long-axis out-of-plane" view, the operators cannot see the whole course of the needle and also do not obtain complete information on the surrounding tissue. Thus, the risk of unwanted accidental puncture of surrounding structures may be high (Fig. 2C). In the "short-axis lateral in-plane" view, the operators can visualize the surrounding structures simultaneously with visualization of the whole length of the needle. This allows the operator to avoid iatrogenic puncture complications, such as arterial puncture and pneumothorax. Additionally, no adjustment of the probe is required during the procedure. Probe is positioned in transverse orientation just above the clavicle. The needle is inserted at the lateral edge of the ultrasound probe. Hence, the needle can be inserted nearly from the clavicle. This means that the inserted catheter has a more smooth curvature over the clavicle (Fig. 2D). The ultrasound-guided short-axis lateral in-plane technique for IJV cannulation is thought to be the most effective among the four methods. This method should be considered as the first-line technique [5].


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) Short axis, Out-of-Plane (Vertical) approach. (B) Long axis, in-plane approach. (C) Long axis, lateral out-of-plane approach. (D) Short axis, lateral in-plane technique; it allows simultaneous view of the full length of the needle, the internal jugular vein, carotid artery, and adjacent tissue. (E) Puncture needle was inserted at the posterior triangle, which consisted of posterior margin of the sternocleidomastoid muscle, anterior margin of the trapezius muscle, and clavicle. (F) A completely inserted catheter had a smooth curvature over the clavicle while maintaining its horizontal line, and did not show any kinking.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: (A) Short axis, Out-of-Plane (Vertical) approach. (B) Long axis, in-plane approach. (C) Long axis, lateral out-of-plane approach. (D) Short axis, lateral in-plane technique; it allows simultaneous view of the full length of the needle, the internal jugular vein, carotid artery, and adjacent tissue. (E) Puncture needle was inserted at the posterior triangle, which consisted of posterior margin of the sternocleidomastoid muscle, anterior margin of the trapezius muscle, and clavicle. (F) A completely inserted catheter had a smooth curvature over the clavicle while maintaining its horizontal line, and did not show any kinking.
Mentions: In the "short-axis out-of-plane" view, the operators have a very limited view of the needle tip and an adjustment of the probe is needed to have the needle tip aligned with the ultrasound beam. The operators have to coordinate the needle and ultrasound probe movements (Fig. 2A). In the "long-axis in-plane" view, the whole course of the IJV can be seen with the in-plane technique. However, surrounding structures (carotid artery, thyroid, lymph nodes) cannot be visualized. The needle insertion level is higher than that in the other technique as long as the probe length. Although the probe is positioned on the patient's neck with its caudal edge in contact with the clavicle, the needle would be inserted from the cranial edge of the ultrasound probe, away from the clavicle (Fig. 2B). In the "long-axis out-of-plane" view, the operators cannot see the whole course of the needle and also do not obtain complete information on the surrounding tissue. Thus, the risk of unwanted accidental puncture of surrounding structures may be high (Fig. 2C). In the "short-axis lateral in-plane" view, the operators can visualize the surrounding structures simultaneously with visualization of the whole length of the needle. This allows the operator to avoid iatrogenic puncture complications, such as arterial puncture and pneumothorax. Additionally, no adjustment of the probe is required during the procedure. Probe is positioned in transverse orientation just above the clavicle. The needle is inserted at the lateral edge of the ultrasound probe. Hence, the needle can be inserted nearly from the clavicle. This means that the inserted catheter has a more smooth curvature over the clavicle (Fig. 2D). The ultrasound-guided short-axis lateral in-plane technique for IJV cannulation is thought to be the most effective among the four methods. This method should be considered as the first-line technique [5].

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