SONOGRAPHIC GUIDANCE WHEN USING THE RIGHT INTERNAL JUGULAR-VEIN FOR CENTRAL VEIN ACCESS

OBJECTIVE. The intent of this study was to substantiate the advantages of the use of sonographic guidance for central venous access via the right internal jugular vein. SUBJECTS AND METHODS. Eighty sequential p atients requiring central vein access were examined with a hand-held s onography transducer to determine the size, patency, and location of t he right internal jugular vein before puncture. Access to the right in ternal jugular vein was subsequently performed, under sterile conditio ns, using sonographic guidance. Periprocedural complications were pros pectively recorded. Subsequently, we compared our findings with publis hed reports of complications when visible and palpable anatomic landma rks were used for guidance during cannulation of the internal jugular vein. RESULTS. Among these 80 patients, the anatomy of the right inter nal jugular vein was typical in only 57 (71%). In another 13 patients (16%), sonography showed a medial position of the right internal jugul ar vein, anterior to the common carotid artery. In three other patient s (4%), the right internal jugular vein was positioned laterally by mo re than 1 cm. In the remaining seven patients (9%), the vein was throm bosed. its diameter, measured without use of the Valsalva maneuver, al so varied, measuring 0.5-2.0 cm. Cannulation was achieved in all 73 pa tients with a patent right internal jugular vein. One puncture was req uired in 68 patients (93%); two punctures in three other patients (4%) ; and three punctures in the remaining two patients (3%). In no case w as the common carotid artery inadvertently punctured. Only one peripro cedural complication occurred, and it was unrelated to the use of sono graphic guidance. CONCLUSION. Sonographic guidance for central vein ac cess via the right internal jugular vein is safer and more efficient t han the traditional landmark approach.