Document Detail

Optimal head rotation for internal jugular vein cannulation when relying on external landmarks.
MedLine Citation:
PMID:  15385337     Owner:  NLM     Status:  MEDLINE    
External anatomic landmarks have traditionally been used to approximate the location of the neck blood vessels to optimize central venous cannulation of the internal jugular vein (IJV) while avoiding the common carotid artery (CCA). Head rotation affects vessel orientation, but most landmark techniques do not specify its optimal degree. We simulated catheter insertion via both an anterior and central approach to the right IJV using an ultrasound probe held in the manner of a syringe and needle in 49 volunteers. Increased head rotation from 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 60 degrees to the left of midline was associated with higher probability of a simulated needle contacting the IJV and the CCA. For both approaches, the risk of CCA contact was <10% for head rotations of <or=45 degrees. Increased body surface area (BSA) and body mass index (BMI) were associated with more CCA contact at head rotations of 45 degrees or 60 degrees. To optimize IJV contact while reducing the likelihood of inadvertent contact with the CCA, the head should be rotated no more than 30 degrees in patients with high BMI or BSA, but it may be turned to 60 degrees if BMI or BSA is low.
Jeremy A Lieberman; Kayode A Williams; Andrew L Rosenberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  99     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-23     Completed Date:  2004-10-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  982-8, table of contents     Citation Subset:  AIM; IM    
Department of Anesthesiology, University of Michigan Medical Center, Room 1G323 UH, Box 0048, Ann Arbor, USA.
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MeSH Terms
Body Mass Index
Body Surface Area
Carotid Artery Injuries / prevention & control
Catheterization, Peripheral / methods*
Jugular Veins / anatomy & histology*,  physiology,  ultrasonography
Neck / anatomy & histology*
Posture / physiology*
Prospective Studies
Treatment Outcome

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

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