[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 Groshong catheter (GC) is commonly used as a peripherally inserted central catheter (PICC), and the external jugular vein (EJV) is not a common route for central venous access (CVA). Therefore, external jugular venous catheterization (EJVC) using a GC is rare. However, our experience has shown that this procedure is safe and simple for CVA. To assess the utility of EJVC using the GC for CVA. CVA was done using a GC via the EJV with a single puncture employing the maximal barrier precaution technique. Between March 2005 and June 2007, we attempted to perform EJVC using a GC via the EJV for 331 patients. Among of these patients, 301 patients received successful catheterization (success rate: 301/331 = 90.9%). The total period of catheter insertion was 4601 days, and the mean insertion period was 15.1 days (range 2-147 days). The main complications of catheter insertion were malposition (8/301; 2.7%) and, oozing or hematoma formation (8/301; 2.7%). There were no severe complications such as nerve injury, pneumothorax or arterial bleeding. Our experience demonstrates that EJVC using the GC is acceptable for CVA.Journal of Surgical Oncology 08/2008; 98(1):67-9. · 2.64 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