Department of Thoracic Surgery, Konya Education and Research Hospital, Konya, Turkey.
J Cardiothorac Vasc Anesth. 2012 Dec;26(6):985-8. doi: 10.1053/j.jvca.2012.07.005. Epub 2012 Sep 18.
Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn.
A prospective, randomized, controlled study.
An education and research hospital and a university-affiliated hospital.
Eighty patients requiring central venous catheterization in the right IJV.
Under general anesthesia, patients were positioned in the Trendelenburg position with extension of the neck. In the rotated group, the head was rotated to the left at >45°. In the neutral group, the head was placed in the neutral position. Right IJV cannulation was performed using the central approach with the needle angled toward the ipsilateral nipple. The primary outcome variable was the cumulative success rate, which was defined as IJV puncture achieved in the first 3 attempts using a finder needle. A p value of <0.05 was considered statistically significant.
Groups were similar in terms of demographic data. The success rates of finder needle passes into the IJV on the first attempt were 87.5% and 37.5% (p < 0.05), and the cumulative success rates on the first 3 attempts were 97.5% and 57.5% in the rotated and neutral groups, respectively (p < 0.05). Carotid artery puncture only occurred in 2 patients in the rotated group.
Because of the lower success rate, the neutral head position is not an attractive alternative for IJV catheterization when compared with the rotated head position in a central landmark IJV approach.
中央静脉通路仍然是多种临床情况的基石程序。超声研究表明，头部旋转会增加颈内静脉与颈动脉重叠的程度。作者评估在解剖标志引导下进行颈内静脉（IJV）穿刺时，头部保持中立位是否是旋转颈部至头向>45°的替代方法。
前瞻性、随机、对照研究。
教育和研究医院和大学附属医院。
80 名需要在右侧 IJV 进行中心静脉导管插入术的患者。
全身麻醉下，患者取头高脚低位并伸展颈部。在旋转组中，头向左旋转>45°。在中立组中，头保持中立位。使用中央入路，将针头朝向对侧乳头，进行右侧 IJV 穿刺。主要观察变量是累积成功率，定义为使用 finder 针首次尝试 3 次内穿刺到 IJV。p 值<0.05 被认为具有统计学意义。
两组患者在人口统计学数据方面相似。在首次尝试中，finder 针进入 IJV 的成功率分别为 87.5%和 37.5%（p<0.05），在旋转组和中立组中，首次 3 次尝试的累积成功率分别为 97.5%和 57.5%（p<0.05）。仅在旋转组的 2 名患者中发生了颈动脉穿刺。
由于成功率较低，与旋转头位相比，在中央标志 IJV 入路中，头部中立位不是 IJV 置管的一个有吸引力的替代方法。
