Document Detail

The accuracy of the central landmark used for central venous catheterization of the internal jugular vein.
MedLine Citation:
PMID:  16632804     Owner:  NLM     Status:  MEDLINE    
We simulated needle paths based on the central landmark used for central venous catheterization of the internal jugular vein. We obtained ultrasound images to quantify the landmark's accuracy (precision and bias) in 107 subjects placed in Trendelenburg position with their heads turned 30-35 degrees. We also determined the frequency of simulated carotid artery puncture. The simulated needle path missed the middle 80% of the lumen of the internal jugular vein in 34% of subjects (95% confidence interval [CI], 25% to 44%) and traversed the carotid artery in 26% of subjects (95% CI, 18% to 35%). Both events occurred in 20% of subjects (95% CI, 13%-29%). The landmark had a medial bias of 3.7 mm (95% CI, 2.7 to 4.8); it was more often (77 of 104 subjects) medial to the center of the right internal jugular vein (P < 0.001). The landmark was more likely to miss the internal jugular vein (odds ratio, 3.11; P < 0.016) and intersect the carotid (odds ratio, 3.03; P < 0.024) in obese patients. The central landmark should not be expected to yield frequent success on first needle pass without risk of carotid puncture because of its imprecision and bias. The measured bias should be considered when the central landmark is used for central venous catheterization.
Peter L Bailey; Emmett E Whitaker; Linda S Palmer; Laurent G Glance
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  102     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-05-17     Revised Date:  2007-01-23    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1327-32     Citation Subset:  AIM; IM    
Department of Anesthesiology, University of Rochester, Rochester, New York, USA.
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MeSH Terms
Aged, 80 and over
Catheterization, Central Venous / methods*
Confidence Intervals
Jugular Veins / anatomy & histology,  radiography*
Logistic Models
Middle Aged
Sensitivity and Specificity
Supine Position
Comment In:
Anesth Analg. 2007 Jan;104(1):216; author reply 216-7   [PMID:  17179282 ]

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

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