Document Detail

Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization.
MedLine Citation:
PMID:  21983370     Owner:  NLM     Status:  MEDLINE    
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.
DESIGN: Prospective, randomized, controlled study.
SETTING: A university-affiliated hospital.
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.
Taewan Lim; Ho-Geol Ryu; Chul-Woo Jung; Yunseok Jeon; Jae-Hyon Bahk
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-18     Completed Date:  2012-03-12     Revised Date:  2012-09-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  491-4     Citation Subset:  AIM; IM    
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
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MeSH Terms
Catheterization, Central Venous / adverse effects,  methods*
Follow-Up Studies
Hematoma / etiology,  prevention & control*
Hospitals, University
Jugular Veins / ultrasonography*
Middle Aged
Preoperative Care / methods
Prospective Studies
Punctures / adverse effects,  methods*
Risk Assessment
Statistics, Nonparametric
Thoracic Surgery / methods*
Treatment Outcome
Ultrasonography, Interventional
Comment In:
Crit Care Med. 2012 Aug;40(8):2534-5; author reply 2535-6   [PMID:  22809945 ]
Crit Care Med. 2012 Feb;40(2):678-9   [PMID:  22249048 ]
Crit Care Med. 2012 Aug;40(8):2533; author reply 2534   [PMID:  22809943 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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