Anton Kasatkin, Anna Nigmatullina

LERANING OBJECTIVE

Increase safety of IJV catheterization in obese patients via lateral short-axis in-plane technique

Short neck and bad acceptability of head-down tilt position (Trendelenburg position) in obese patients may cause failed ultrasound-guided internal jugular vein (IJV) cannulation.

Short neck essentially limits the capability of IJV catheterization in-plane/long-axis technique. Inapplicability of head-down tilt position limits the possibility of vein size enlargement in patients with hypovolemia. Small size of the IJV (less than 7 mm) may impair the safety of short-axis/out-of-plane cannulation technique and enhance the probability of through venipuncture.

AIM

Establish access efficiency and safety for lateral short-axis in-plane technique for IJV catheterization in obese patients.

METHODS

A total of 14 adult Intensive Care Unit patients were enrolled in the study.

Entry criteria included medical indications for central venous catheter insertion, body mass index (kg/m2) ≥ 35, age 18-65 years old.

Ultrasound examination of the IJV was performed using US-scanner with a linear array transducer 5-14 MHz. Values of the medial-to-lateral diameter of the vein during inspiration and expiration (in cross section, short-axis) were determined before puncturing.

The patients were placed in a horizontal position. Efficacy and safety of the IJV catheterization were evaluated in the number of venipuncture attempts and complications.

RESULTS

The average value of body mass index in the patients was 39.4±4.3 kg/m2. IJV catheterization at a lateral access was performed in 12 patients (IJV diameter during inhalation was more than 7 mm), using a lateral oblique approach – in three patients (IJV diameter was less than 7 mm).

In these cases the ultrasonic transducer was rotated 20-30° clockwise to increase the viewable size of the vein. This maneuver allowed us to increase the lateral-to-medial size of the IJV up to 9-10 mm.

Venipuncture in all patients was performed at the first attempt. Complications were not noted. Catheter placement accuracy was controlled by ultrasound and radiological methods.

CONCLUSION

Lateral access allows performing successful IJV catheterization with ultrasonic guidance in patients with obesity and short neck.

This technique provides ultrasonic imaging of the puncture needle at a long axis and performing venipuncture along an axis of the maximum (lateral-to-medial) size of the vein.