[External jugular vein as central venous access in intensive care patients].
ABSTRACT The authors studied 98 patients in need of a central venous line route, joined into two different groups: Group 1 - 62 (63.3%) patients, and Group 2 - 36 (36.7%). All the patients had a visible external jugular vein while on Trendelenburg position. According to the Seldinger technique using a J-wire guided catheter the authors describe a maneuver to make it easy to advance the catheter. Patients from Group 1 had the technique applied by operators with previous experience, and patients from Group 2 by operators with no previous experience, but under supervision. There was no significant difference in the success rate between these two groups: 96.8% in Group 1 and 94.4% in Group 2 (p > 0.5). There was only one case of local bleeding, managed by local compression.
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ABSTRACT: The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completely replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.Critical care (London, England) 01/2005; 8(6):478-84. · 4.72 Impact Factor
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ABSTRACT: The external jugular vein (EJV) is an attractive alternative for percutaneous central venous catheterization (PCVC), with fewer complications. The inability to pass the guide wire into the superior vena cava (SVC) is, however, a major reason for the failure of this approach. The authors report a modification of the Seldinger technique to increase the effectiveness of this procedure in children. Between May 2008 and June 2009, we performed 100 PCVCs consecutively in children using the Seldinger technique through the EJV (Step 1). In cases in which the guide wire could not be passed into the SVC, the guide wire was kept in the EJV; and only the catheter was introduced into the central venous position (Step 2). Differences between the standard and modified Seldinger techniques were analyzed. The procedure with the standard Seldinger technique (Step 1) was successful in 13 (13%) out of 100 patients. In 84 (96.5%) of the 87 remaining patients, PCVC was achieved with the modified Seldinger technique, without the insertion of the guide wire until the SVC (Step 2). Altogether, 97 catheters (97%) were successfully inserted, with 85 (87.6%) correctly positioned in the SVC. In addition, there were 7 (7%) clinically irrelevant hematomas during catheterization. The EJV is an excellent alternative anatomical location for the completion of PCVC in children. Placing the guide wire in a central position is not essential to the success rate of this approach. The proposed modified Seldinger technique allowed PCVC to be performed through the EJV safely and with a high success rate in children and adolescents.Journal of Pediatric Surgery 09/2012; 47(9):1742-7. · 1.38 Impact Factor
- Critical Care 01/2004; 8:1-1. · 4.93 Impact Factor