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1.
Indian Pediatr ; 60(1): 72-74, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36639975

RESUMO

We retrieved data of ultrasound-guided neonatal internal jugular vein (IJV) cannulations done between November, 2020 and March, 2021. Of the 33 ultrasound-guided IJV cannulation in neonates, 32 were successful with overall success rate of 97%. Median (IQR) number of attempts per insertion was 2 (1,3.5). There were no major complications observed during the insertion of the catheter. In one instance, inadvertent carotid artery puncture was encountered, without significant bleeding.


Assuntos
Cateterismo Venoso Central , Recém-Nascido , Humanos , Cateterismo Venoso Central/efeitos adversos , Veias Jugulares/diagnóstico por imagem , Neonatologistas , Ultrassonografia de Intervenção , Estudos Prospectivos
2.
Sci Rep ; 13(1): 1500, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36707658

RESUMO

We estimate central venous pressure (CVP) with force-coupled ultrasound imaging of the internal jugular vein (IJV). We acquire ultrasound images while measuring force applied over the IJV by the ultrasound probe imaging surface. We record collapse force, the force required to completely occlude the vein, in 27 healthy subjects. We find supine collapse force and jugular venous pulsation height (JVP), the clinical noninvasive standard, have a linear correlation coefficient of r2 = 0.89 and an average absolute difference of 0.23 mmHg when estimating CVP. We perturb our estimate negatively by tilting 16 degrees above supine and observe decreases in collapse force for every subject which are predictable from our CVP estimates. We perturb venous pressure positively to values experienced in decompensated heart failure by having subjects perform the Valsalva maneuver while the IJV is being collapsed and observe an increase in collapse force for every subject. Finally, we derive a CVP waveform with an inverse three-dimensional finite element optimization that uses supine collapse force and segmented force-coupled ultrasound data at approximately constant force.


Assuntos
Veias Jugulares , Manobra de Valsalva , Humanos , Pressão Venosa Central , Veias Jugulares/diagnóstico por imagem , Ultrassonografia/métodos , Pressão Venosa
3.
World J Surg Oncol ; 21(1): 10, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36647096

RESUMO

BACKGROUND: Donor-recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution. CASE PRESENTATION: A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery. CONCLUSION: The triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein.


Assuntos
Veias Jugulares , Transplantes , Masculino , Humanos , Pessoa de Meia-Idade , Veias Jugulares/cirurgia , Veia Safena/transplante , Esvaziamento Cervical , Tireoidectomia
6.
Surg Radiol Anat ; 45(1): 55-63, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36520166

RESUMO

PURPOSE: During retrosigmoid craniotomy, the mastoid emissary vein (MEV) can be a source of considerable bleeding during the operation, especially when the larger diameter MEV or sigmoid sinus is torn. In this study, we evaluated the relevant structure of the MEV for their anatomy and applied the data in surgery to summarize their clinical significance. METHODS: The posterior craniocervical regions of 15 silicon-injected Chinese human cadaver specimens were dissected to expose the MEV and adjacent structures. Fifty-one patients who were scheduled to undergo retrosigmoid craniotomy were selected. All patients underwent preoperative routine CT of the head. The relevant data were collected on cadaveric anatomy and CT. Eventually, all patients underwent retrosigmoid craniotomy and the MEV was observed during the operation. RESULTS: In cadaver specimens, the prevalence of the MEV was 90.0%. It originated from the middle and lower parts of the posterior wall of the sigmoid sinus and extended in the posterior direction in the mastoid process, usually having 1-2 external openings (86.7%) and only 1 internal opening. The intraosseous courses of the MEV were classified as straight and curved. The straight type accounted for 57.9%, and the curved type for 42.1%. The mean diameter of the MEV was 1.84 ± 0.85 mm, and the straight length of the MEV inside the mastoid process was 11.93 ± 3.58 mm. In 16.7% and 6.7% of all cadaver specimens, the MEV diameter was greater than 2.5 and 4 mm, respectively. In 51 patients (bilateral), routine head CT scan showed the MEV in 49.0% of the patients, and the MEV diameter was greater than 2.5 and 4 mm, respectively, in 17.6% (18/102) and 3.9% (4/102) of the cases. During surgery (unilateral) in the 51 patients, 48 had the MEV and 3 had no MEV. None of the patients had sigmoid sinus tears or massive bleeding. CONCLUSION: In the process of retrosigmoid craniotomy, detailed anatomical knowledge of the MEV, well-planned CT scan, and meticulous microsurgical techniques are key for successful operation, which can reduce the occurrence of complications.


Assuntos
Processo Mastoide , Crânio , Humanos , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Processo Mastoide/anatomia & histologia , Crânio/anatomia & histologia , Veias Jugulares/anatomia & histologia , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Cadáver
7.
J Appl Physiol (1985) ; 134(2): 217-229, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36476158

RESUMO

Altered gravity affects hemodynamics and blood flow in the neck. At least one incidence of jugular venous thrombosis has been reported in an astronaut on the International Space Station. This investigation explores the impact of changes in the direction of the gravitational vector on the characteristics of the neck arteries and veins. Twelve subjects underwent graded tilt from 45° head-up to 45° head-down in 15° increments in both supine and prone positions. At each angle, the cross-sectional area of the left and right common carotid arteries (ACCA) and internal jugular veins (AIJV) were measured by ultrasound. Internal jugular venous pressure (IJVP) was also measured by compression sonography. Gravitational dose-response curves were generated from experimental data. ACCA did not show any gravitational dependence. Conversely, both AIJV and IJVP increased in a nonlinear fashion with head-down tilt. AIJV was significantly larger on the right side than the left side at all tilt angles. In addition, IJVP was significantly elevated in the prone position compared with the supine position, most likely because of raised intrathoracic pressure while prone. Dose-response curves were compared with existing experimental data from parabolic flight and spaceflight studies, showing good agreement on an acute timescale. The quantification of jugular hemodynamics as a function of changes in the gravitational vector presented here provides a terrestrial model to reference spaceflight-induced changes, contributes to the assessment of the pathogenesis of spaceflight venous thromboembolism events, and informs the development of countermeasures.NEW & NOTEWORTHY Flow stasis and thrombosis have been identified in the jugular vein during spaceflight. We measured the area and pressure of the internal jugular vein and the area of the common carotid artery in graded head-up and head-down tilt. Experimental data are used to generate gravitational dose-response curves for the measured variables, demonstrating that jugular vein area and pressure exhibit a nonlinear response to altered gravity. Gravitational dose-response curves show good agreement with spaceflight and parabolic flight studies.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Voo Espacial , Humanos , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Hemodinâmica/fisiologia , Astronautas , Posicionamento do Paciente , Veias Jugulares/fisiologia
8.
Crit Care Med ; 51(2): e37-e44, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36476809

RESUMO

OBJECTIVES: This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). DESIGN: A prospective, single-blinded, open label, parallel-group, randomized trial. SETTING: Two university-affiliated ICUs in Poland (Opole and Lublin). PATIENTS: Mechanically ventilated intensive care patients with clinical indications for central venous line placement. INTERVENTIONS: Patients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. MEASUREMENTS AND MAIN RESULTS: The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79). CONCLUSIONS: No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.


Assuntos
Veia Axilar , Cateterismo Venoso Central , Humanos , Veia Axilar/diagnóstico por imagem , Estudos Prospectivos , Veias Jugulares/diagnóstico por imagem , Estado Terminal/terapia , Respiração Artificial , Ultrassonografia de Intervenção/métodos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos
9.
Cardiovasc Intervent Radiol ; 46(1): 43-48, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36509940

RESUMO

INTRODUCTION: Clinical outcomes of implantable port catheters (IPCs) placed via alternative veins such as the external jugular and cervical collaterals have not been well established. This investigation evaluates the short- and long-term outcomes of IPCs inserted via alternate cervical veins (ACV) compared to traditionally inserted IPCs via the internal jugular vein (IJV). MATERIALS AND METHODS: A total of 24 patients who received an IPC between 2010 and 2020 via an ACV-defined as the external jugular vein, superficial cervical vein, or unnamed collateral veins-were identified. Based on power analysis, a matched control group of 72 patients who received IPCs via the IJV was identified. Non-inferiority analysis for port complications was performed between the two groups based on the selected non-inferiority margin of 20%. Secondary end points included complication-free survival and comparison of complications by the time at which they occurred. RESULTS: ACV access was non-inferior to traditional access for overall complications. Alternate access resulted in fewer complications than traditional access with an estimated reduction of - 7.0% [95% CI - 23.6%, 39.7%]. There was no significant difference in peri-procedural and post-procedural complications between the two groups. Complication-free survival was also equivalent between the two groups. CONCLUSION: IPC placement via ACVs was non-inferior to IPCs placed via traditional access through the IJV. When abnormal pathology obviates the use of IJV access, other cervical veins may be considered prior to seeking alternate locations such as femoral, translumbar, inferior vena cava, and hepatic veins.


Assuntos
Cateterismo Venoso Central , Dispositivos de Acesso Vascular , Humanos , Cateterismo Venoso Central/métodos , Cateteres de Demora , Veias Jugulares , Veia Cava Inferior
10.
Beijing Da Xue Xue Bao Yi Xue Ban ; 54(6): 1167-1171, 2022 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-36533350

RESUMO

OBJECTIVE: To summarize the surgical experience of totally implantable venous access port in children with malignant tumors, and to explore the coping methods of surgical complications. METHODS: The clinical data of 165 children with malignant tumors implanted in totally implantable venous access port in Department of Pediatric Surgery, Peking University First Hospital from January 2017 to December 2019 were retrospectively analyzed. The operation process, complications and treatment of complications were observed and counted. RESULTS: The children in this group were divided into external ju-gular vein incision group (n=27) and internal jugular vein puncture group (n=138) according to different surgical methods, and the latter was divided into ultrasound guided puncture group (n=95) and blind puncture group (n=43). No puncture complications occurred in the external jugular vein incision group, and the average time for successful catheterization and the number of times for catheter to enter the superior vena cava were more than those in the internal jugular vein puncture group [(9.26±1.85) min vs. (5.76±1.56) min, (1.93±0.87) times vs. 1 time], with statistical significance. The average time of successful catheterization, the success rate of one puncture, the average number of punctures and the incidence of puncture complications in the ultrasound guided right internal jugular vein puncture group were better than those in the blind puncture group [(5.36±1.12) min vs. (6.67±1.99) min, 93.68% (89/95) vs. 74.42% (32/43), (1.06±0.24) times vs. (1.29±0.55) times, 2.11% (2/95) vs. 11.63% (5/43)], with statistically significant differences. The total incidence of complications in this study was 12.12% (20/165). Pneumothorax occurred in 1 case, artery puncture by mistake in 1 case, local hematoma in 5 cases, venous access port related infection in 4 cases (venous access port local infection in 2 cases, catheter related blood flow infection in 2 cases), subcutaneous tissue thinning on the surface of port seat in 2 cases, port seat overturning in 1 case, poor transfusion in 4 cases (catheter discount in 1 case, catheter blockage in 3 cases), and foreign bodies gathered around the subcutaneous pipeline in 2 cases. There were no complications, such as catheter rupture, detachment and catheter clamping syndrome. CONCLUSION: Totally implantable venous access port can provide safe and effective infusion channels for children with malignant tumors. Right external jugular vein incision and ultrasound-guided right internal jugular vein puncture are reliable surgical methods for children's totally implantable venous access port implantation. Surgeons should fully understand the complications of the venous access port, take measures to reduce the occurrence of complications, and properly handle the complications that have occurred.


Assuntos
Cateterismo Venoso Central , Neoplasias , Humanos , Criança , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Estudos Retrospectivos , Veia Cava Superior , Veias Jugulares/cirurgia , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia
11.
Tunis Med ; 100(7): 520-524, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36571740

RESUMO

BACKGROUND: Several clinical practice guidelines strongly support the use of ultrasound guidance (USG) for internal jugular vein catheterization. The level of evidence concerning the use of USG for subclavian vein (SCV) cannulation remains low. AIM: To compare the effectiveness and safety of USG and anatomical landmarks approaches for cannulation of SCV. METHODS: This was a prospective randomized study. Patients aged over 18 years old who requiring elective central venous catheterization were included. Non-inclusion criteria were thrombosis of the vein or major coagulopathy. All catheterizations were performed by two anaesthesiology residents. Patients were randomized into two groups: ultrasound guidance group (US group) and anatomical landmarks (LM group). The main outcome was the success rate. The secondary outcomes were the first attempt success rate and the incidence of complications. RESULTS: Seventy patients were included (35 in each group). The success rate was higher in US group compared to LM group without statistical significance (100% vs 85.7%; p=0.054). The first attempt success rate was significantly higher in the US group (82.9% vs. 40%; p <10-3). The incidence of mechanical complications was significantly lower in the US group compared to LM group (5.7% vs. 37.1%; p=0,001). CONCLUSION: according to our study, US guidance for SCV catheterization seems to be an interesting alternative to anatomical landmarks approaches.


Assuntos
Cateterismo Venoso Central , Veia Subclávia , Humanos , Adulto , Pessoa de Meia-Idade , Estudos Prospectivos , Veia Subclávia/diagnóstico por imagem , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia , Cateterismo Venoso Central/efeitos adversos , Veias Jugulares/diagnóstico por imagem
12.
Sci Prog ; 105(4): 368504221146066, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36540044

RESUMO

BACKGROUND: We assessed the outcomes of a push-pull monorail technique to overcome a difficult anatomical course through the left internal jugular vein in implantable port insertions. METHODS: From December 2018 to May 2021, a total of 5326 patients were referred for implantable port insertion in our interventional unit, among which 472 cases were requested for insertion on the left side. Our monorail technique was applied only when the catheter tip entered the azygos vein instead of the superior vena cava (n = 8). The technique consists of a puncture at the distal tip of the port catheter with a 21-gauge micropuncture needle, advancing a 0.018-inch hair-wire to the guide, providing support for the pre-assembled port, and advancing the microsheath over the hair-wire to prevent extrusion of the catheter. RESULTS: The push-pull monorail technique was performed in eight patients, and all cases were technically successful, exhibiting a technical success rate of 100%. There were no immediate or delayed complications. CONCLUSIONS: The push-pull monorail technique is helpful in overcoming the difficult anatomical course through the left internal jugular vein during implantable port insertion.


Assuntos
Cateterismo Venoso Central , Humanos , Cateterismo Venoso Central/métodos , Veia Cava Superior , Veias Jugulares , Punções/métodos
13.
Curr Oncol ; 29(12): 9235-9241, 2022 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-36547137

RESUMO

Internal jugular vein tumor thrombus is an extremely rare condition in thyroid carcinoma, but it does exist. Correlated with greater aggressiveness with a higher incidence of distant metastases at diagnosis and a higher recurrence rate, this important prognostic element should be systematically investigated by ultrasound operators in all patients presenting with thyroid carcinoma. The patient's follow-up must be careful. This can be a trap that surgeons must look for in their preoperative checklist. We report the case of a 58-year-old woman with an IJV thrombus associated with multiple bone metastases. She underwent successful surgical treatment, and postoperative pathology showed a poorly differentiated follicular carcinoma of the thyroid and a tumor thrombus in the internal jugular vein.


Assuntos
Cirurgiões , Trombose , Neoplasias da Glândula Tireoide , Feminino , Humanos , Pessoa de Meia-Idade , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Veias Jugulares/patologia , Neoplasias da Glândula Tireoide/diagnóstico
14.
Physiol Rep ; 10(24): e15525, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36541216

RESUMO

Sheep are popular large animals in which to model human disorders and to study physiological processes such as cerebrospinal fluid dynamics. However, little is known about vascular compensatory mechanisms affecting cerebrospinal fluid pressures during acute postural changes in sheep. Six female white Alpine sheep were anesthetized to investigate the interactions of the vascular and cerebrospinal fluid system by acquiring measurements of intracranial pressure and central and jugular venous pressure during passive postural changes induced by a tilt table. The cross-sectional area of the common jugular vein and venous blood flow velocity was recorded. Anesthetized sheep showed bi-phasic effects of postural changes on intracranial pressure during tilting. A marked collapse of the jugular vein was observed during head-over-body tilting; this is in accordance with findings in humans. Active regulatory effects of the arterial system on maintaining cerebral perfusion pressure were observed independent of tilting direction. Conclusion: Anesthetized sheep show venous dynamics in response to posture-induced changes in intracranial pressure that are comparable with those in humans.


Assuntos
Postura , Veias , Humanos , Feminino , Animais , Ovinos , Postura/fisiologia , Pressão Intracraniana/fisiologia , Veias Jugulares/fisiologia , Pressão Arterial , Pressão Venosa , Líquido Cefalorraquidiano , Circulação Cerebrovascular
15.
Nagoya J Med Sci ; 84(4): 877-883, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36544603

RESUMO

Perioperative blindness, especially posterior ischemic optic neuropathy (PION), is an uncommon but potentially devastating complication. We report a case of a 65-year-old male patient who underwent laryngopharyngectomy, bilateral neck dissection, and free jejunum flap reconstruction, but then experienced PION in his right eye following postoperative bleeding and bilateral internal jugular veins (IJVs) compression. Despite systemic corticosteroid therapy, his visual recovery prognosis was poor. The specific mechanism responsible for PION remains unclear, and no therapy has been shown to improve this condition. As such, prevention of perioperative PION remains the only available strategy. Surgeons should be aware of this rare potential complication and its risk factors and strive to avoid it. As postoperative bleeding and IJV compression are one of important risk factors for PION, avoiding these are critical.


Assuntos
Neuropatia Óptica Isquêmica , Masculino , Humanos , Idoso , Neuropatia Óptica Isquêmica/etiologia , Veias Jugulares , Hemorragia Pós-Operatória/etiologia , Esvaziamento Cervical/efeitos adversos , Prognóstico , Complicações Pós-Operatórias/etiologia
16.
Innovations (Phila) ; 17(6): 562-566, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36571246

RESUMO

Internal jugular phlebectasia is a rare entity in which there is a fusiform dilatation of the internal jugular vein (IJV), usually presenting as a neck mass or tinnitus. The jugular bulb (JB) is an enlarged confluence connecting the sigmoid sinus and the IJV. It has been suggested that JB abnormality might also cause vertigo and pulsatile tinnitus. This prospective interventional study involved 15 patients with pulsatile tinnitus associated with internal jugular phlebectasia. Four patients presented with recurrent vertigo attacks. IJV diameter at rest ranged from 11 to 18 mm. Eight patients have had inner ear bone dehiscence, and 40% had high JB. All cases were treated by surgical fixation using a ringed polytetrafluoroethylene graft extending from the costoclavicular joint to the sigmoid sinus under fluoroscopic guidance. Tinnitus disappeared immediately postoperatively in all cases, followed by the disappearance of vertigo on the fourth day. Two cases reported thrombosis of the graft in the sixth and seventh months but maintained symptomatic improvement. Recurrence was reported in 2 cases while the grafts were patent. Surgical fixation by replacing the jugular vein and bulb with a synthetic graft may offer an excellent surgical option for relieving vascular tinnitus, especially in these young patients in whom endovascular therapy may not be a durable treatment.


Assuntos
Zumbido , Humanos , Zumbido/etiologia , Zumbido/cirurgia , Estudos Prospectivos , Veias Jugulares/cirurgia , Vertigem/complicações
17.
J Biomed Opt ; 27(11)2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36385200

RESUMO

SignificanceThe internal jugular veins (IJV) are critical cerebral venous drainage pathways that are affected by right heart function. Cardiovascular disease and microgravity can alter central venous pressure (CVP) and venous return, which may contribute to increased intracranial pressure and decreased cardiac output. Assessing jugular venous compliance may provide insight into cerebral drainage and right heart function, but monitoring changes in vessel volume is challenging.AimWe investigated the feasibility of quantifying jugular venous compliance from jugular venous attenuation (JVA), a noncontact optical measurement of blood volume, along with CVP from antecubital vein cannulation.ApproachCVP was progressively increased through a guided graded Valsalva maneuver, increasing mouth pressure by 2 mmHg every 2 s until a maximum expiratory pressure of 20 mmHg. JVA was extracted from a 1-cm segment between the clavicle and midneck. The contralateral IJV cross-sectional area (CSA) was measured with ultrasound to validate changes in the vessel size. Compliance was calculated using both JVA and CSA between four-beat averages over the duration of the maneuver.ResultsJVA and CSA were strongly correlated (median and interquartile range) over the Valsalva maneuver across participants (r = 0.986, [0.983, 0.987]). CVP more than doubled on average between baseline and peak strain (10.7 ± 4.4 vs. 25.8 ± 5.4 cmH2O; p < 0.01). JVA and CSA increased nonlinearly with CVP, and both JVA- and CSA-derived compliance decreased progressively from baseline to peak strain (49% and 56% median reduction, respectively), with no significant difference in compliance reduction between the two measures (Z = - 1.24, p = 0.21). Pressure-volume curves showed a logarithmic relationship in both CSA and JVA.ConclusionsOptical jugular vein assessment may provide new ways to assess jugular distention and cardiac function.


Assuntos
Veias Jugulares , Manobra de Valsalva , Humanos , Veias Jugulares/diagnóstico por imagem , Pressão Venosa Central , Ultrassonografia/métodos
19.
Medicine (Baltimore) ; 101(43): e31249, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316874

RESUMO

OBJECTIVE: We hypothesized that when a right-handed operator catheterizes the left internal jugular vein (IJV), the tip of the needle might be positioned closer to the center of the vessel after puncture if the operator is standing in the patient's left axillary line, rather than standing cephalad to the patient. METHODS: The study randomly allocated 44 patients undergoing elective surgery under general anesthesia with planned left central venous catheterization to either conventional (operator stood cephalad to the patient) or intervention (operator stood in the patient's axillary line) groups. The left IJV was catheterized by 18 anesthesiologists. The distance between the center of the vessel and the needle tip, first-attempt success rate, and procedure time were compared. RESULTS: The distance from the needle tip to the center of the IJV after needle puncture was 3.5 (1.9-5.5) and 3.2 (1.7-4.9) cm in the conventional and intervention groups, respectively (P = .47). The first-attempt success rate was significantly higher in the intervention group (100% vs 68.2%, P = .01). Overall time to successful guidewire insertion was faster in the intervention group (P = .007). CONCLUSIONS: There was no significant difference in needle tip position when the right-handed operator was standing in the patient's left axillary line compared to standing cephalad to the patient during left IJV catheterization. However, it increased the first-attempt success rate and reduced the overall time for guidewire insertion.


Assuntos
Cateterismo Venoso Central , Humanos , Cateterismo Venoso Central/métodos , Veias Jugulares/diagnóstico por imagem , Veias Braquiocefálicas/diagnóstico por imagem , Agulhas , Ultrassonografia de Intervenção/métodos
20.
Medicine (Baltimore) ; 101(43): e31207, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316929

RESUMO

BACKGROUND: This study aimed to detect the correlation of central venous pressure (CVP) with the internal jugular vein (IJV), common carotid artery (CCA), femoral vein (FV), and femoral artery (FA) diameters measured with ultrasound (USG) in patients under mechanical ventilation to evaluate whether they are suitable to be used as an alternative low-cost and noninvasive method for the detection of CVP. METHODS: A total of 40 patients aged from 18 to 90 who had been receiving therapy in the intensive care unit (ICU) were included in the study. Central venous catheter was placed into the patients through right IJV or subclavian vein in their first 24-hour of hospitalization and the right atrium pressure (RAP) was measured from the catheter, the tip of which was confirmed to reach right atrium. In the same session, CCA, IJV, FA, and FV diameters were measured with USG and their correlations with CVP were calculated. In addition, correlations of the measured venous and artery diameters between each other were detected as well. RESULTS: There was a significantly high correlation between CVP and CCA diameter (R = 0.603, P < .000). There was a significantly low correlation between CVP and IJV diameter (R = 0.352, P = .026), a significantly low correlation between FA and FV diameters (R = 0.317, P = .047), a significantly low correlation between FA and CCA diameters (R = 0.330, P = .038), and a significantly low correlation between IJV and CCA diameters (R = 0.364, P = .020). CONCLUSION: CVP and CCA diameters exhibited a high correlation. For detection of CVP, the ultrasonographic CCA diameter measurement can be used as an alternative noninvasive method which is easy to use and minimally affected by measurement errors of individuals and which has low learning curve compared with the other measurement methods.


Assuntos
Cateterismo Venoso Central , Veias Jugulares , Humanos , Veias Jugulares/diagnóstico por imagem , Pressão Venosa Central , Veia Femoral/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Ultrassonografia , Cateterismo Venoso Central/métodos
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