Jugular vein cannulation success unaffected by head position
MedWire News: Keeping patients' heads in a neutral position, as opposed to rotated 45 degrees, during ultrasound-guided internal jugular vein (IJV) cannulation does not increase the risk for complications, research shows.
"This could have a practical clinical impact when neck rotation must be avoided, such as with head trauma patients with neck collars, or in patients with a previous cervical fusion," say Massimo Lamperti (Neurological Institute Besta, Milan, Italy) and colleagues.
A neutral position can also be desirable in infants, because it minimizes overlap between the carotid artery (CA) and the IJV and therefore reduces the risk for accidental CA puncture. The six anesthesiologists participating in the current study had to hold their hands and the needle in a more lateral position on a more curved surface than usual. However, they felt the patient's head position did not affect the difficulty of the procedure overall.
As reported in Anesthesia and Analgesia, the anesthesiologists performed ultrasound-guided IJV cannulation in 662 patients who were randomly assigned to have their heads placed in a neutral position and 670 assigned to 45-degree rotation. Head rotation is usually used to facilitate cannulation using a landmark technique, a practice that persists despite guideline recommendations for ultrasound guidance, say Lamperti et al.
All cannulations were successful, with an overall complication rate of 13.0% and a major complication rate of just 0.75% (all CA punctures). This rate is lower than generally reported for cannulation using a landmark technique, say the researchers. "Furthermore, we noted that after performing approximately 25 procedures, our incidence of procedure-related complications became zero."
The rate of major complications was similar in the two groups, at 0.9% and 0.6% in the neutral position and 45-degree rotation groups, respectively. The corresponding rates of all complications were 13.2% and 12.6%.
The risk for complications was increased in women and in obese patients, and it rose with increasing American Society of Anesthesiologists physical status and with IJV depth. The risk declined with smaller IJV diameter and if the IJV was anterior to the CA.
The total procedure time, from ultrasound visualization of the IJV to aspiration of venous blood via the catheter, was 4 minutes for both groups. This shows that "even when using the ultrasound technique with a sterile maneuver, access time is short and comparable to the landmark technique," says the team.
By Eleanor McDermid