Department of Radiology, Faculty of Medicine, Selcuk University, Konya, Turkey.
Ren Fail. 2013;35(4):492-6. doi: 10.3109/0886022X.2013.774672. Epub 2013 Mar 12.
The aim of this study is to determine the optimal angle of needle entry in the sagittal plane for internal jugular vein (IJV) catheterization with the central approach while the head is in the neutral position.
The contrast-enhanced carotid artery computed tomography angiographies of 123 consecutive patients were retrospectively reviewed. The point of merger between the sternal and clavicular heads of the sternocleidomastoid muscle was assumed as a clinical entry (CE) point. The angle between CE point and the center of the IJV, the depth, diameter of the vessels and the degree of overlap between the IJV and carotid artery (CA) were measured.
The angles between the CE point and the center of the IJVs were similar, 7° ± 13° medial and 8° ± 12° medial on the right and the left side, respectively. The center of IJVs from the CE point was between 0° and 16° toward the medial in 79.8% on the right side and 89.9% on the left side of patients. The diameters of the right IJVs were greater than the left IJVs (p = 0.001). The depth from the skin and overlap between IJV and CA did not vary between the two sides.
When a central approach is used for right internal jugular vein (RIJV) cannulation with a neutral head position, the orientation of the angle of needle entry (i.e., 16°) medially in the sagittal plane may quadruple the success rate of RIJV catheterization compared to the success rate of a laterally oriented angle of entry as recommended by the classic method.
本研究旨在确定头中立位时，经颈内静脉（IJV）中央入路行颈内静脉置管时矢状面内进针的最佳角度。
回顾性分析 123 例连续患者的增强颈动脉 CT 血管造影。胸锁乳突肌胸骨和锁骨头的交点被认为是临床进针点（CE 点）。测量 CE 点与 IJV 中心之间的夹角、深度、血管直径以及 IJV 和颈动脉（CA）之间的重叠程度。
CE 点与右侧和左侧 IJVs 中心之间的夹角相似，分别为 7°±13°和 8°±12°。在右侧和左侧患者中，79.8%和 89.9%的 IJVs 中心位于 CE 点向内侧 0°至 16°的位置。右侧 IJVs 的直径大于左侧 IJVs（p=0.001）。皮肤至 IJVs 和 CA 之间的重叠深度在两侧之间没有差异。
当头中立位时采用中央入路行右侧颈内静脉（RIJV）置管时，与经典方法推荐的外侧进针角度相比，矢状面内进针角度（即 16°）向内侧的方向可能会使 RIJV 置管的成功率提高四倍。
