Ultrasound Imaging of Neck Blood Vessels in Pregnant and Non-Pregnant Women
Summary
There is no data regarding success rates and incidence of carotid punctures during central venous cannulation (CVC) in the pregnant patients. We hypothesize that because of the anatomical and physiological changes associated with pregnancy, these patients are at higher risk of procedure failure and carotid puncture than the general population. The purpose of our study is to determine the success rate and incidence of carotid punctures using an ultrasound-simulated procedure in pregnant and non-pregnant patients.
Description
There is no data regarding success rates and incidence of carotid punctures during central venous cannulation (CVC) in pregnant patients. We hypothesize that because of the anatomical and physiological changes associated with pregnancy, these patients are at higher risk of procedure failure and carotid puncture than the general population. The purpose of our study is to determine the success rate and incidence of carotid punctures using an ultrasound-simulated procedure in pregnant and non-pregnant patients.
Pregnant patients and adult female volunteers (controls) were recruited. Subjects were placed supine with wedge under the right hip, and head turned 35 degrees to the left. Two different approaches for CVC, the central landmark and the palpatory approach were used. The ease of identification of the landmarks was noted. CVC was simulated using an ultrasound probe, on pre-marked points. Ultrasound images were obtained, within the same parasagittal plane, directed 30 degrees caudad, in a manner simulating how a syringe and needle would be placed for central venous cannulation. The investigator placing the probe was blinded to the image being generated. The vertical cursor of the ultrasound, which serves to delineate the path of a needle, was placed in the image. If the cursor intersects the vein, the attempt is considered successful. If the first attempt is not successful, the investigator placing the probe was asked to redirect the probe to the second and if necessary to the third marked point. This was done for each approach. If the cursor intersects the carotid artery, the attempt is considered an accident and no further attempts were made. In addition to determining the success rate and the incidence of carotid punctures, the relative position of vein and artery was studied in each patient. For each approach, the best image was recorded, and three experienced anesthesiologist scored the images for vein and artery degree of overlapping.
Study Design
Time Perspective: Prospective
Conditions
Pregnancy
Intervention
Internal jugular vein cannulation, ultrasound
Location
Mount Sinai Hospital
Toronto
Ontario
Canada
M5G 1X5
Status
Completed
Source
Samuel Lunenfeld Research Institute, Mount Sinai Hospital
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00464828
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Subclavian Vein
The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein.
Transverse Sinuses
The two large endothelium-lined venous channels that begin at the internal occipital protuberance at the back and lower part of the CRANIUM and travels laterally and forward ending in the internal jugular vein (JUGULAR VEINS). One of the transverse sinuses, usually the right one, is the continuation of the SUPERIOR SAGITTAL SINUS. The other transverse sinus is the continuation of the straight sinus.
Lemierre Syndrome
A superinfection of the damaged oropharyngeal mucosa by FUSOBACTERIUM NECROPHORUM leading to the secondary septic THROMBOPHLEBITIS of the internal jugular vein.
Upper Extremity Deep Vein Thrombosis
DEEP VEIN THROMBOSIS of an upper extremity vein (e.g., AXILLARY VEIN; SUBCLAVIAN VEIN; and JUGULAR VEINS). It is associated with mechanical factors (Upper Extremity Deep Vein Thrombosis, Primary) secondary to other anatomic factors (Upper Extremity Deep Vein Thrombosis, Secondary). Symptoms may include sudden onset of pain, warmth, redness, blueness, and swelling in the arm.
Cerebrospinal Fluid Shunts
Tubes inserted to create communication between a cerebral ventricle and the internal jugular vein. Their emplacement permits draining of cerebrospinal fluid for relief of hydrocephalus or other condition leading to fluid accumulation in the ventricles.
Clinical Trials
Estimation of Internal Jugular Vein Central Venous Pressure (CVP) by Ultrasound
Objectives: 1. To study the validity and reliability of estimation of the central venous pressure by measurement of internal jugular vein size using 2-dimensional ultrasound....
Internal Jugular Vein Cross Sectional Area
The Trendelenburg position is used to distend the central veins, improving both success and safety of vascular cannulation. The purpose of this study is to measure the cross-sectional are...
Ultrasound Scanning of Vascular Access Sites
Inadvertent puncture of an unintended object in a vascular access procedure is common and can lead to serious consequences. Inadvertent common carotid artery (CCA) puncture while targeting...
Non-invasive Assessments of Central Venous Pressure
Background: Estimates of central venous pressure (CVP) can be very helpful in guiding fluid therapy in the intensive care unit, operating room or emergency room. Current standard technique...
To evaluate the effect of a 2-stage approach to the internal jugular vein when performing a central venous catheterization compared to the traditional one stage approach on the incidence o...
PubMed Articles
Ultrasound-guided internal jugular vein cannulation.
Ultrasound simulation of internal jugular vein cannulation in pregnant and non-pregnant women.
BACKGROUND: Pregnancy alters the anatomic landmarks for internal jugular vein (IJV) cannulation. In this study, IJV cannulation was simulated, and success of the technique was evaluated using ultrasou...
Mandating ultrasound usage for internal jugular vein cannulation.
We performed descending thoracic aortic repair via posterolateral thoracotomy using retrograde cerebral perfusion with direct cannulation into the left internal jugular vein. No postoperative neurolog...
An iatrogenic complication of internal jugular vein catheterization for hemodialysis.
BACKGROUND: Central venous catheterization is increasingly performed as a temporary vascular access for hemodialysis therapy in developing countries and it can be associated with serious complications...
