Journal of Emergencies, Trauma, and Shock

LETTER TO EDITOR
Year
: 2016  |  Volume : 9  |  Issue : 4  |  Page : 157-

Internal jugular vein cannulation without the risk of double wall punctures


Anton Aleksandrovich Kasatkin1, Aleksandr Livievich Urakov1, Aleksei Valerianovich Shchegolev2, Anna Raisovna Nigmatullina1,  
1 Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia
2 Department of Anesthesiology and Intensive Care, Kirov Military Medical Academy, Saint-Petersburg, Russia

Correspondence Address:
Anton Aleksandrovich Kasatkin
Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk
Russia




How to cite this article:
Kasatkin AA, Urakov AL, Shchegolev AV, Nigmatullina AR. Internal jugular vein cannulation without the risk of double wall punctures.J Emerg Trauma Shock 2016;9:157-157


How to cite this URL:
Kasatkin AA, Urakov AL, Shchegolev AV, Nigmatullina AR. Internal jugular vein cannulation without the risk of double wall punctures. J Emerg Trauma Shock [serial online] 2016 [cited 2021 Mar 1 ];9:157-157
Available from: https://www.onlinejets.org/text.asp?2016/9/4/157/193387


Full Text

Dear Editor,

Ultrasound guidance does not always guarantee a successful cannulation and lack of complications. [1] Thus, an ultrasound of the internal jugular vein (IJV) with a maximum diameter of <7 mm is associated with decreased cannulation success. [2] The vein puncture with a small diameter may result in double wall punctures. As a consequence, the carotid artery injury, nerve, and pleura damages may result from double wall punctures. [3] The valsalva maneuver and the trendelenburg position are considered to be well-known methods for increasing the size of the IJV. Application of these maneuvers in emergency medicine may be limited.

The cannulation method offered by us takes into account the presence of IJV respiratory excursion and individual anatomic features of vein location. [4] It enables to perform an effective puncture of the vein with a small diameter (experimental group) even without the trendelenburg position [Table 1]. Preanalysis of the venipuncture angle by the formula α = arcsin (a/c), where a is the lowest value of a vein diameter, c is the longitudinal length of a needle bevel, provides full immersion of needle bevel into the vein lumen without the risk of double wall punctures. Angle calculation is helpful in case when IJV diameter is less than the longitudinal length of a needle bevel. The venipuncture at the moment of patient's expiration enables to reduce the risk of double wall punctures at the expense of vein diameter increase at this moment and vein collapse exclusion. [5] It is recommended to define an alternative vascular access with a maximum IJV diameter of <4 mm.{Table 1}

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Jarwani BS, Shah H, Shah A, Madariya M. Ultrasound guided Deep Vein cannulation: "Perpendicular Insertion Technique (PIT)", an edge over "Conventional Insertion Technique (CIT)". J Emerg Trauma Shock 2015;8:149-53.
2Mey U, Glasmacher A, Hahn C, Gorschlüter M, Ziske C, Mergelsberg M, et al. Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients. Support Care Cancer 2003;11:148-55.
3Lewin MR, Stein J, Wang R, Lee MM, Kernberg M, Boukhman M, et al. Humming is as effective as Valsalva's maneuver and Trendelenburg's position for ultrasonographic visualization of the jugular venous system and common femoral veins. Ann Emerg Med 2007;50:73-7.
4Urakov AL, Kasatkin AA, Nigmatullina AR. The dynamics of changing internal jugular veins diameter based on increasing head elevation angle. Indian J Crit Care Med 2015;19:610-2.
5Kasatkin AA, Urakov AL, Nigmatullina AR. Inventors. Method for Internal Jugular Catheterisation. Russian Federation Patent RU 2573337 C1; January 20, 2016.