The accuracy of the central landmark used for central venous catheterization of the internal jugular vein

Anesthesia and Analgesia
Peter L BaileyLaurent G Glance

Abstract

We simulated needle paths based on the central landmark used for central venous catheterization of the internal jugular vein. We obtained ultrasound images to quantify the landmark's accuracy (precision and bias) in 107 subjects placed in Trendelenburg position with their heads turned 30-35 degrees. We also determined the frequency of simulated carotid artery puncture. The simulated needle path missed the middle 80% of the lumen of the internal jugular vein in 34% of subjects (95% confidence interval [CI], 25% to 44%) and traversed the carotid artery in 26% of subjects (95% CI, 18% to 35%). Both events occurred in 20% of subjects (95% CI, 13%-29%). The landmark had a medial bias of 3.7 mm (95% CI, 2.7 to 4.8); it was more often (77 of 104 subjects) medial to the center of the right internal jugular vein (P < 0.001). The landmark was more likely to miss the internal jugular vein (odds ratio, 3.11; P < 0.016) and intersect the carotid (odds ratio, 3.03; P < 0.024) in obese patients. The central landmark should not be expected to yield frequent success on first needle pass without risk of carotid puncture because of its imprecision and bias. The measured bias should be considered when the central landmark is used for central venou...Continue Reading

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Citations

Aug 17, 2005·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Peter Bailey, Mirsad Dupanovic
Sep 11, 2010·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Naveed SiddiquiJose C A Carvalho
Oct 12, 2011·Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre·Radmilo J JankovicNenad N Savic
Sep 19, 2009·Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists·Kuang-Yi TsengKoung-Shing Chu
Apr 15, 2014·Journal of the Chinese Medical Association : JCMA·Hung-Wei ChengPin-Tarng Chen
Dec 21, 2006·Anesthesia and Analgesia·Ling YeJin Liu
Jun 19, 2009·Anesthesia and Analgesia·Andrew B Leibowitz, Marc A Rozner
Feb 22, 2007·Anesthesia and Analgesia·Peter L BaileyScott McIntosh
Jun 24, 2015·Anaesthesia and Intensive Care·D J FaulkeC Nixon

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