A GUIDE TO PREVENTING DEEP INSERTION OF THE CANNULATION NEEDLE DURINGCATHETERIZATION OF THE INTERNAL JUGULAR-VEIN

Objective:Accidental puncture of the vertebral artery during the inter nal jugular vein cannulation produces lethal sequelae. To prevent this , the cannulation needle must not he inserted too deeply, However, the re is no useful guide for the optimal length of insertion of the needl e for accessing the internal jugular vein. The authors examined the le ngth of the needle needed to reach the internal jugular vein with thre e different sizes of needle (16, 20, and 23 gauge). Design: Prospectiv e study. Setting: An academic medical center. Participants: Patients u ndergoing cardiovascular surgeries. Interventions: The cannulation of the internal jugular vein was performed through the right internal jug ular vein by the high approach. The needle was slowly advanced, keepin g constant negative pressure on the syringe at 45 degrees to the skin surface until blood was aspirated; if blood was not aspirated during i nsertion, the needle was slowly withdrawn until blood was aspirated, T he distance to the internal jugular vein was assessed by calculating t he entire length of needle minus the length of needle from the skin su rface to the hub. Measurements and Main Results: The mean distance to the internal jugular vein ranged from 15.0 to 21.5 mm, and the larger needle required the longer distance to the internal jugular vein. Conc lusions: The results may be a useful guide to prevent too deep inserti on of the needle during internal jugular vein catheterization, especia lly when teaching residents who have limited experience with internal jugular Vein catheterization. Copyright (C) 1997 by W.B. Saunders Comp any.