Seo Hyungseok, Jang Dong-Min, Yi Jung-Min, Min Hong-Gi, Hwang Jai-Hyun
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2014 Jul 22;9(7):e103089. doi: 10.1371/journal.pone.0103089. eCollection 2014.
Although ultrasonography is recommended in internal jugular vein (IJV) catheterization, the landmark-guided technique should still be considered. The central landmark using the two heads of the sternocleidomastoid muscle is widely used, but it is inaccurate for IJV access. As an alternative landmark, we investigated the accuracy of the new landmark determined by inspection of the respiratory jugular venodilation and direct IJV palpation in right IJV access by ultrasonography.
Thirty patients were enrolled. After induction of anesthesia, the central landmark was marked at the cricoid cartilage level (M1) and the alternative landmark determined by inspection of the respiratory jugular venodilation and direct palpation of IJV was also marked at the same level (M2). Using ultrasonography, the location of IJV was identified (M3) and the distance between M1 and M3 as well as between M2 and M3 were measured. The median (interquartile range) distance between the M2 and M3 was 3.5 (2.0-6.0) mm, compared to 17.5 (12.8-21.3) mm between M1 and M3. (P<0.001) The dispersion of distances between M2 and M3 was significantly smaller than between M1 and M3. (P<0.001) The visibility of respiratory jugular venodilation was associated with CVP more than 4 mmHg. Limitations of the present study are that the inter-observer variability was not investigated and that the visibility of the alternative landmark can be limited to right IJV in adults.
The alternative landmark may allow shorter distance for the right side IJV access than the central landmark and can offer advantages in right IJV catheterization when ultrasound device is unavailable.
Clinical Research Informational Service KCT0000812.
尽管超声检查被推荐用于颈内静脉（IJV）置管，但仍应考虑使用体表标志引导技术。使用胸锁乳突肌两头的中央体表标志被广泛应用，但用于IJV穿刺时并不准确。作为一种替代体表标志，我们通过超声检查研究了在右侧IJV穿刺中，通过观察呼吸时颈静脉扩张和直接触诊IJV所确定的新体表标志的准确性。
纳入30例患者。麻醉诱导后，在环状软骨水平标记中央体表标志（M1），同时在同一水平标记通过观察呼吸时颈静脉扩张和直接触诊IJV所确定的替代体表标志（M2）。使用超声检查确定IJV的位置（M3），并测量M1与M3以及M2与M3之间的距离。M2与M3之间的距离中位数（四分位间距）为3.5（2.0 - 6.0）mm，而M1与M3之间的距离为17.5（12.8 - 21.3）mm。（P < 0.001）M2与M3之间距离的离散度明显小于M1与M3之间的离散度。（P < 0.001）呼吸时颈静脉扩张的可见性与中心静脉压（CVP）大于4 mmHg相关。本研究的局限性在于未研究观察者间的变异性，且替代体表标志的可见性可能仅限于成人右侧IJV。
与中央体表标志相比，替代体表标志可能使右侧IJV穿刺的距离更短，并且在没有超声设备时，在右侧IJV置管中具有优势。
临床研究信息服务KCT0000812。
