Nötral baş pozisyonunda karotis arter palpasyonu yardımıyla internal jugular ven kanülasyonunun başarı oranı

Yıl 2013, Cilt: 23 Sayı: 2, 39 - 42, 01.01.2013

Burhan Apilioğulları Seda Özbek Betül Kozanhan Ergün Gündüz Emine Altınay Zubeyir Cebeci Çigdem Sizer Ali Özgül Saltali Derya Çelik Jale Bengi Çelik

Öz

Amaç: İnternal jugular ven İJV kanülasyonu bazı klinik durumlarda baş nötral pozisyonda tutularak yapılmalıdır. Ancak bu pozisyonda hangi anatomik işaretleme noktasının kullanılması gerektiği açık değildir. Bu çalışmanın amacı baş nötral pozisyonda iken karotis arter KA palpasyonu kullanılarak yapılan sağ İJV kanülasyonunun başarı oranlarını araştırmaktır. Gereç ve yöntem: Bu prospektif randomize çalışma iki aşamada dizayn edildi. Birinci aşama: Birbirini takip eden 30 servikal bilgisayarlı tomografi görüntüsü çalışma öncesi sağ İJV ve KA arasındaki ilişkiyi belirlemek için incelendi. İkinci aşama: Sağ İJV kanülasyonu yapılması planlanan toplam 150 hasta çalışmaya alındı. Hastaların başı nötral pozisyonda tutuldu. Genel anestezi altında trendelenburg pozisyonu ve soluk sonu pozitif basınç uygulandı. Sağ İJV kanülasyonu 10 farklı klinisyen tarafından KA palpasyonu işaret noktası alınarak, iğneye medial yada laterale açı verilmeksizin uygulandı. Öncelikli hedefimiz iğne ile ilk üç girişimde sağ İJV ulaşabilme başarı oranlarının belirlenmesi idi. Bulgular: İğnenin toplam üç girişimde sağ İJV’ye ulaşma oranı %96,7 idi. Klinisyenler arasında başarı oranları açısından istatistiksel fark yoktu. Hastaların hiçbirinde KA delinmedi. Sonuç: Başın nötral pozisyonda tutulduğu hastalarda sağ İJV kanülasyonu için yüksek başarı oranlarından dolayı KA işaret noktası olarak etkili bir şekilde kullanılabilir

Anahtar Kelimeler

İnternal jugular ven, karotis arter, komplikasyon, santral venöz kanülasyon

The success rate of carotid artery palpation guided internal jugular venous cannulation in patients with a neutral head position

Öz

Objectives: Internal jugulary venous cannulation IJV should be performed in patients while maintaining a neutral head position for a variety of clinical conditions. However, in this position, the landmark that should be used is unclear. Our aim was to evaluate the success rate of right IJV cannulation guided by carotid artery CA palpation in a patient with a neutral head position. Materials and methods: The prospective randomized study was designed as two parts. Part 1: Prior to this study we conducted a priliminary evalu- ation with CT scans of 30 consecutive patients to determine the relationship with right IJV and the CA. Part 2: A total of 150 patients who planned right IJV cannulation were included in the study. Each patient’s head was placed in the neutral position. Under general anesthesia, the patient was positioned in the Trendelenburg position and ventilation was provided with a positive end-expiratory pres- sure. Right IJV cannulation was performed by ten different clinicians using CA palpation to guide the needle, which was not angled eighter medially or laterally. The primary outcome variable was the cumulative success rate, which was defined as right IJV puncture achieved in the first 3 attempts using a needle. Results: The cumulative success rates on the first 3 attempts were 96.7%. No differences were observed between the clinicians. CA puncture did not occur in any patient. Conclusion: CA guided right IJV cannulation can be used effectively due to its high success rate in patients whose heads are maintained in a neutral position

Anahtar Kelimeler

Internal jugulary venous, carotid artery, complication, central venous cannulation

Kaynakça

• Apiliogullari B, Kara I, Apiliogullari S, Arun O, Saltali A, Celik JB. Is a neutral head position as effective as head rotation during landmark-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial. J Cardiothorac Vasc Anesth 2012;26:985-8.
• Ozbek S, Apiliogullari S, Erol C, Kivrak AS, Kara I, Uysal E, Koplay M, Duman A. Optimal angle of needle entry for internal jugular vein catheterization with a neutral head position: A CT Study. Ren Fail 2013;35:492-6.
• Hessel EA 2nd. Landmark-guided internal jugular vein cannula- tion: is there still a role and, if so, what should we do about it? J Cardiothorac Vasc Anesth 2012;26:979-8.
• Sulek CA, Gravenstein N, Blackshear RH, Weiss L. Head rotation during internal jugular vein cannulation and the risk of carotid ar- tery puncture. Anesth Analg 1996;82:125-8.
• Lieberman JA, Williams KA, Rosenberg AL. Optimal head rotati- on for internal jugular vein cannulation when relying on external landmarks. Anesth Analg 2004;99:982-8.
• Wang R, Snoey ER, Clements RC, Hern HG, Price D. Effect of head rotation on vascular anatomy of the neck: an ultrasound study. J Emerg Med 2006;3:283-6.
• Saitoh T, Satoh H, Kumazawa A, Nobuhara M, Machii M, Tanaka T, Shiraki K, Saotome M, Urushida T, Katoh H, Hayashi H. Ultra- sound analysis of the relationship between right internal jugular vein and common carotid artery in the lefthead-rotation and he- ad-flexion position. Heart Vessels 2013;28:620-5.
• Suarez T, Baerwald JP, Kraus C. Central venous access: the effects of approach, position, and head rotation on internal jugular vein cross-sectional area. Anesth Analg 2002;95:1519-24.
• Oda M, Fukushima Y, Hirota T, Tanaka A, Aono M, Sato T. The para-carotid approach for internal jugular catheterization. J Anesth 1981;36:896-900.
• Lee SC, Han SS, Shin SY, Lim YJ, Kim JT, Kim YH. Relationship between positive end-expiratory pressure and internal jugular vein cross-sectional area. ActaAnaesthesiol Scand 2012;56:840-5.
• Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol 1953;39:368-76.
• Ishizuka M, Nagata H, Takagi K, Kubota K. Right internal jugular vein is recommended for central venous catheterization. J Invest Surg 2010;23:110-4.
• Patel HV, Sainaresh VV, Jain SH et al. Carotid-jugular arteriove- nous fistula: a case report of an iatrogenic complication following internaljugular vein catheterization for hemodialysis access. He- modial Int 2011;15:404-6.
• Gong Y, Xu HX, Lin M, Gu Y. An iatrogenic complication of in- ternal jugular vein catheterization for hemodialysis. Ir J Med Sci 2012;181:135-7.
• Lew YS, Lim SK. Cannulation of internal jugular vein in neutral head position. Med J Malaysia 1998;53:227-31.
• Maecken T, Marcon C, Bomas S, Zenz M, Grau T. Relationship of the internal jugular vein to the common carotid artery: impli- cations for ultrasound-guided vascularaccess. Eur J Anaesthesiol 2011;28:351-5.
• Maecken T, Marcon C, Bomas S, Zenz M, Grau T. Relationship of the internal jugular vein to the common carotid artery: impli- cations for ultrasound-guided vascularaccess. Eur J Anaesthesiol 2011;28:351-5.