Hwang Jin-Young, Ju Jae-Woo, Min Seong-Won, Do Sang-Hwan, Ryu Jung-Hee
aDepartment of Anesthesiology and Pain Medicine, SNU-SMG Boramae Medical CenterbDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, SeoulcDepartment of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seong-nam, Republic of Korea.
Eur J Emerg Med. 2016 Aug;23(4):292-297. doi: 10.1097/MEJ.0000000000000260.
We assessed and compared two landmarks (conventional vs. high approach) used in internal jugular vein (IJV) cannulation with respect to the degree of overlap with the carotid artery (CA) and the cross-sectional area (CSA) of the IJV using ultrasonography.
Forty-eight adult patients were included. Using ultrasonography, the percentage overlaps with the CA and the CSA of both IJVs were measured in the supine and Trendelenburg positions using conventional and high approaches. With the conventional approach, the IJV is penetrated at the apex of Sedillot's triangle, formed by the clavicle and the sternal and clavicular heads of the sternocleidomastoid muscle. The high approach involves the midpoint between the sternal notch and the mastoid process.
The degree of overlap with the CA was 30.5 (7.5-69.4)% [median (interquartile range)] and 0.0 (0.0-25.4)% with the conventional and high approaches, respectively, for the right IJV (P<0.001) in the Trendelenburg position with 30° head rotation. The CSA of the right IJV was 1.22 (0.92-2.01) and 0.98 (0.79-1.72) cm with the conventional and high approaches, respectively (P<0.001), in the Trendelenburg position with 30° head rotation. IJV was more deeply positioned using the high approach than the conventional approach (P<0.001).
The high approach for IJV cannulation decreased both the degree of overlap with the CA and CSA of the IJV and increased the depth of the IJV from the skin compared with the conventional approach.
我们使用超声检查评估并比较了颈内静脉（IJV）置管中使用的两个标志点（传统标志点与高位标志点）与颈动脉（CA）的重叠程度以及颈内静脉的横截面积（CSA）。
纳入48例成年患者。使用超声检查，在仰卧位和头低脚高位时，分别采用传统标志点法和高位标志点法测量双侧颈内静脉与颈动脉的重叠百分比以及颈内静脉的横截面积。传统标志点法是在由锁骨以及胸锁乳突肌的胸骨头和锁骨头形成的塞迪洛特三角顶点处穿刺颈内静脉。高位标志点法是在胸骨切迹与乳突尖之间的中点处穿刺。
在头低脚高位且头部旋转30°时，右侧颈内静脉采用传统标志点法与颈动脉的重叠程度为30.5（7.5 - 69.4）%[中位数（四分位间距）]，采用高位标志点法时为0.0（0.0 - 25.4）%（P<0.001）。在头低脚高位且头部旋转30°时，右侧颈内静脉采用传统标志点法的横截面积为1.22（0.92 - 2.01）cm，采用高位标志点法时为0.98（0.79 - 1.72）cm（P<0.001）。与传统标志点法相比，高位标志点法使颈内静脉位置更深（P<0.001）。
与传统标志点法相比，颈内静脉置管的高位标志点法降低了与颈动脉的重叠程度以及颈内静脉的横截面积，并增加了颈内静脉距皮肤的深度。
