Ultrasound evaluation of central veinsin the intensive care unit:effects of dynamic manoeuvres
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To determine: (1) the proportion of small (< 5 mm) or thrombosed internal jugular veins (IJV) and femoral veins (FV) in which catheter placement would be difficult without ultrasound guidance; (2) which position increases central vein sizes and may facilitate cannulation of these vessels.
Twelve-bed adult medical intensive care unit.
Patients and participants
Sixty patients (62 ± 19 years, SAPS II score 36 ± 17).
Ultrasound examinations of the IJV and FV in supine, Trendelenburg (T) and reverse Trendelenburg (Ti) positions.
Measurements and results
Maximum diameter and cross-sectional area (CSA) were measured. Venous catheter placement would have been difficult (diameter < 5 mm) or even impossible (thrombosis) for 22% of right IJV, 13% of left IJV, 2% of left and 2% of right FV. In the T position, the CSA of the IJV increased (right IJV: 1.7 ± 1.4 to 2.01 ± 1.34 cm2, left IJV: 1.18 ± 0.81 to 1.34 ± 0.85 cm2; p < 0.05) and theCSA of the FV decreased (right FV: 1.42 ± 0.61 to 1.22 ± 0.58 cm2, left FV: 1.51 ± 0.62 to 1.26 ± 0.58 cm2; p < 0.05). In the Ti position, the CSA of the IJV decreased (right IJV: 1.7 ± 1.4 to 1.35 ± 1.35 cm2, left IJV: 1.18 ± 0.81 to 0.87 ± 0.62 cm2; p < 0.05) and the CSA of the FV increased (right FV: 1.42 ± 0.61 to 1.66 ± 0.65 cm2, left FV: 1.51 ± 0.62 to 1.65 ± 0.68 cm2; p < 0.05). In two-thirds of patients, the right IJV was significantly larger than the left IJV.
Ultrasonography should be performed before at least central venous catheter placement to detect the presence of deep vein thrombosis or vessels less than 5 mm in diameter. Some positions increase veins' diameter at least internally, T position increasing IJV size and Ti position increasing FV size.
- Hatfield A, Bodenham A (1999) Portable ultrasound for difficult central venous access. Br J Anaesth 82:822–826
- Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24:2053–2058 CrossRef
- Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY (1997) Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med 23:916–919 CrossRef
- Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S (1986) Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 146:259–261 CrossRef
- Denys BG, Uretsky BF (1991) Anatomical variations of internal jugular vein location: impact on central venous access. Crit Care Med 19:1516–1519 CrossRef
- Chastre J, Cornud F, Bouchama A, Viau F, Benacerraf R, Gibert C (1982) Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein: prospective evaluation by phlebography. N Engl J Med 306:278–281 CrossRef
- Fry WR, Clagett GC, O'Rourke PT (1999) Ultrasound-guided central venous access. Arch Surg 134:738–741 CrossRef
- Denys BG, Uretsky BF, Reddy PS (1993) Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 87:1557–1562
- Gordon AC, Saliken JC, Johns D, Owen R, Gray RR (1998) US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 9:333–338 CrossRef
- Mallory DL, Shawker T, Evans RG, Mcgee WT, Brenner M (1990) Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation. Crit Care Med 18:1269–1273 CrossRef
- Arnason T, Wells PS, Forster AJ (2007) Appropriateness of diagnostic strategies for evaluating suspected venous thromboembolism. Thromb Haemost 97:195–201
- Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK (2007) Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med 5:57–62 CrossRef
- Snow V, Qaseem A, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal JB, Bass EB, Weiss KB, Green L, Owens DK (2007) Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 146:204–210
- Lobato EB, Sulek CA, Moody RL, Morey TE (1999) Cross-sectional area of the right and left internal jugular veins. J Cardiothorac Vasc Anesth 13:136–138 CrossRef
- Lichtenstein D, Saifi R, Augarde R, Prin S, Schmitt JM, Page B (2001) The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization. Intensive Care Med 27:301–305 CrossRef
- Lukish J, Valladares E, Rodriguez C, Patel K, Bulas D (2002) Classical positioning decreases subclavian vein cross-sectional area in children. J Trauma 53:272–275
- Armstrong PJ, Sutherland R, Scott DH (1994) The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 38:229–231 CrossRef
- Samy Modeliar S, Sevestre-Pietri MA, Slama M (2005) Venous ultrasonography in medical intensive care. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 585–591
- Ultrasound evaluation of central veinsin the intensive care unit:effects of dynamic manoeuvres
Intensive Care Medicine
Volume 34, Issue 2 , pp 333-338
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Internal jugular vein
- Femoral vein
- Dynamic manoeuvres
- Cross-sectional area
- Industry Sectors
- Author Affiliations
- 1. Unité de réanimation, service de néphrologie, CHU sud, 80054 Cedex 1, Amiens, France
- 2. Laboratoire d’explorations fonctionnelles vasculaires, service de chirurgie vasculaire et thoracique, CHU sud, Amiens, France
- 3. Unité INSERM, ERI 12, Amiens, France