5 research outputs found
Anatomical location of the two landmarks in the patient.
<p>M1 is the central landmark (white arrow), determined by the apex of the triangle between the two heads of the sternocleidomastoid muscle. M2 is the alternative landmark (black arrow), determined by the inspection of respiratory jugular venodilation and direct internal jugular vein palpation.</p
The Accuracy of the New Landmark Using Respiratory Jugular Venodilation and Direct Palpation in Right Internal Jugular Vein Access
<div><p>Background</p><p>Although ultrasonography is recommended in internal jugular vein (IJV) catheterization, the landmark-guided technique should still be considered. The central landmark using the two heads of the sternocleidomastoid muscle is widely used, but it is inaccurate for IJV access. As an alternative landmark, we investigated the accuracy of the new landmark determined by inspection of the respiratory jugular venodilation and direct IJV palpation in right IJV access by ultrasonography.</p><p>Methods and Findings</p><p>Thirty patients were enrolled. After induction of anesthesia, the central landmark was marked at the cricoid cartilage level (M1) and the alternative landmark determined by inspection of the respiratory jugular venodilation and direct palpation of IJV was also marked at the same level (M2). Using ultrasonography, the location of IJV was identified (M3) and the distance between M1 and M3 as well as between M2 and M3 were measured. The median (interquartile range) distance between the M2 and M3 was 3.5 (2.0–6.0) mm, compared to 17.5 (12.8–21.3) mm between M1 and M3. (<i>P</i><0.001) The dispersion of distances between M2 and M3 was significantly smaller than between M1 and M3. (<i>P</i><0.001) The visibility of respiratory jugular venodilation was associated with CVP more than 4 mmHg. Limitations of the present study are that the inter-observer variability was not investigated and that the visibility of the alternative landmark can be limited to right IJV in adults.</p><p>Conclusion</p><p>The alternative landmark may allow shorter distance for the right side IJV access than the central landmark and can offer advantages in right IJV catheterization when ultrasound device is unavailable.</p><p>Trial Registration</p><p>Clinical Research Informational Service <a href="http://cris.nih.go.kr" target="_blank">KCT0000812</a></p></div
Comparison of distances between M1 and M2 from the ultrasound-identified IJV.
<p>Individual and median (interquartile range) distances between M1 and M2 from the ultrasound-identified IJV. For effective representation of the distance, the axes were inverted. The line in the middle box represents the median value and the lateral borders of the box represent interquartile ranges. Individual values are represented as dots (<i>yellow dots</i> in M1 and <i>green dots</i> in M2). M1, the central landmark; M2, the alternative landmark; IJV, internal jugular vein.</p
ROC curve of the central venous pressure for the visible respiratory jugular venodilation.
<p>Area under the curve is given inside the ROC curve. ROC curve, receiver operator characteristic curve.</p