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Transcutaneous pressure at which the internal jugular vein is collapsed on ultrasonic imaging predicts easiness of the venous puncture

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Abstract

Even though we use ultrasound guidance for central venous puncture, we sometimes experience difficulties. We infer that in such cases the vein is collapsed and that the transcutaneous ultrasound probe pressure at which the vein is collapsed (P tc) may predict the easiness of the venous puncture. We measured P tc and the diameter of the internal jugular vein in 47 adult patients in our ICU. After successful puncture, we also measured venous pressure (P v). The patients were divided into two groups based on the number of puncture attempts: ≥3 attempts constituted the “difficult group” and <3 attempts was considered the “easy group:” 33 patients were in the easy group and 14 patients were in the difficult group. The easy group showed significantly higher P tc value (9.3 ± 3.8 vs. 3.5 ± 0.9 cmH2O, P < 0.0001) and larger vertical diameter (9.2 ± 3.1 vs. 6.8 ± 2.2 mm, P = 0.013) than the difficult group. We observed a clear border between the minimum P tc in the easy group (6 cmH2O) and the maximum value in the difficult group (5 cmH2O). In conclusion, venous collapsibility and vertical diameter determine difficulty in performing venous puncture.

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Acknowledgments

Dr. Joo and Dr. Fukui were responsible for study design and analysis and writing the manuscript. Drs. Kooguchi, Sakaguchi, and Shinzato contributed to the conception, results interpretation, and review of the manuscript. No financial support was obtained.

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Authors and Affiliations

  1. Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan

    Woo Jin Joo, Michihiko Fukui, Kunihiko Kooguchi, Masahiro Sakaguchi & Taiichi Shinzato

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  1. Woo Jin Joo
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  2. Michihiko Fukui
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  3. Kunihiko Kooguchi
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  4. Masahiro Sakaguchi
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  5. Taiichi Shinzato
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Correspondence to Woo Jin Joo.

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Joo, W.J., Fukui, M., Kooguchi, K. et al. Transcutaneous pressure at which the internal jugular vein is collapsed on ultrasonic imaging predicts easiness of the venous puncture. J Anesth 25, 308–311 (2011). https://doi.org/10.1007/s00540-010-1077-0

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  • DOI: https://doi.org/10.1007/s00540-010-1077-0

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