KMID : 0360720130260030183
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Journal of the Korean Society Traumatology 2013 Volume.26 No. 3 p.183 ~ p.189
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Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients
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Jun Hyun-Min
Jeong Sung-Min Jeong Ru-Bi Jeon Jin Hong Jong-Kun Shin Tae-Yong Ha Young-Rock Kim Young-Sik
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Abstract
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Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients.
Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV¡¯s anterior-posterior (AP) vessel wall on the longitudinal scan¡¯s midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV¡¯s internal center on screen¡¯s midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5¡Â middle CVP ¡Â10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles.
Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68¡¾0.30, 1.06¡¾0.31, and 1.23¡¾0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups¡¯ mean optimal angles (28.1¡¾6.1, 30.1¡¾4.5, and 28.0¡¾5.0 degree respectively).
Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV¡¯s diameter is altered in proportion to the CVP.
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KEYWORD
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Catheterization, Central vein, Intervention, Ultrasonography
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