Mohammad Helwani1, Nahel Saied2, Shigemasa Ikeda3. 1. Anesthesiologist, Veterans Affairs Medical Center St. Louis, MO. 2. Associate Professor of Anesthesia, Department of Anesthesiology Creighton University School of Medicine Omaha, NE. 3. Professor of Anesthesia, St. Louis University School of Medicine St. Louis, MO.
Abstract
BACKGROUND: Internal jugular vein (IJV) cannulation is a common practice procedure employed by anesthesiologists to access large central veins. The purpose of this study is to examine the accuracy of the use of superficial anatomical landmarks to locate the IJV as well as to delineate differences in accuracy at various levels of anesthesiology trainees, and staff. METHODS: We prospectively evaluated the accuracy of locating the left and right IJV on the skin surface by anesthesiology residents and board certified anesthesiologists. Twenty-four patients with body mass index (BMI) <30 and 24 morbidly obese patients with BMI > 40 were employed across all groups. Ultrasound imaging of the actual IJV course was utilized as a reference. RESULTS: Experienced operators (Third year residents and faculty) achieved better accuracy in locating the IJV compared to first and second year residents. Higher accuracy was achieved when the carotid pulse was used as a landmark compared to the sternocleidomastoid muscle, particularly for experienced operators in morbidly obese patients. Overall, there was no difference in accuracy between the right and left IJV, although medial deviation was greater on the left side. CONCLUSION: The accuracy of locating the IJV on the skin surface improved with operator experience in our anesthesiology training program. Experienced operators improved their accuracy using the carotid pulse as the external landmark. Ultrasound may be a useful tool to improve IJV localization early during training, and for cannulation of the left IJV.
BACKGROUND: Internal jugular vein (IJV) cannulation is a common practice procedure employed by anesthesiologists to access large central veins. The purpose of this study is to examine the accuracy of the use of superficial anatomical landmarks to locate the IJV as well as to delineate differences in accuracy at various levels of anesthesiology trainees, and staff. METHODS: We prospectively evaluated the accuracy of locating the left and right IJV on the skin surface by anesthesiology residents and board certified anesthesiologists. Twenty-four patients with body mass index (BMI) <30 and 24 morbidly obesepatients with BMI > 40 were employed across all groups. Ultrasound imaging of the actual IJV course was utilized as a reference. RESULTS: Experienced operators (Third year residents and faculty) achieved better accuracy in locating the IJV compared to first and second year residents. Higher accuracy was achieved when the carotid pulse was used as a landmark compared to the sternocleidomastoid muscle, particularly for experienced operators in morbidly obesepatients. Overall, there was no difference in accuracy between the right and left IJV, although medial deviation was greater on the left side. CONCLUSION: The accuracy of locating the IJV on the skin surface improved with operator experience in our anesthesiology training program. Experienced operators improved their accuracy using the carotid pulse as the external landmark. Ultrasound may be a useful tool to improve IJV localization early during training, and for cannulation of the left IJV.
Authors: D L Mallory; W T McGee; T H Shawker; M Brenner; K R Bailey; R G Evans; M M Parker; J C Farmer; J E Parillo Journal: Chest Date: 1990-07 Impact factor: 9.410