Anästhesie und klinische Forschung
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Abstrakt

External Jugular Venous Route for Central Venous Access: Our Experience in 563 Surgical Patients

Murali Chakravarthy, Jayaprakash Krishnamoorthy, Seetharamji Nallam, Nagesh Kolur, Aslam Faris, Keshava Reddy, Sudheer Kumar and Simha Rajathadri

Objectives: Though external jugular vein is superficial, adequate sized, isolated from major neurovascular structures and its cannulation fairly simple and comfortable to patients, it is not commonly used. Internal jugular vein cannulation on the other hand is routinely used with reasonable success. This technique is not devoid of complications. In order to make the central venous cannulation safer, the author sought to explore the possibility of using external jugular venous route as the route of first choice to pass the vascular catheters.

Design: A prospective observational study,

Setting: Tertiary referral hospital

Participants: Five hundred sixty three patients requiring central venous cannulation.

Interventions: External jugular venous route as the choice of central venous cannulation.

Measurements and Main Results: The type of the catheter required for the procedure- single, multi lumen, Swan Ganz, dialysis or pacing catheters were inserted via the external jugular vein. Inability to advance the catheter or the guide wire was considered a failed procedure. In the event of a failure to insert and or advance the catheter, from the same point of insertion, internal jugular vein was cannulated. Ultrasound image assistance was taken if needed by the operator. In 411 subjects, the desired catheter was inserted through the EJV. In 378 patients, the catheter was inserted in the first attempt. No life threatening complications occurred even among the cases, where external jugular vein cannulation was not successful. A few malpositions occurred when the external jugular route was chosen. In very obese patients, ultrasound was used to visualize the vein. external jugular route. Methods This observational study assessed the feasibility of EJV cannulation as the preferred route of central venous cannulation. It was conducted in a tertiary referral hospital. The institutional review board clearance and informed patient consent were obtained. The patients were informed that cannulation of EJV was untraditional but safe. If the planned technique was not successful, the ipsilateral IJV would be cannulated. Patients who underwent surgeries during April 2008 to January 2009 were studied. Patients over the age of 18 years, scheduled to undergo surgery requiring central venous cannulation considered prospective candidates to participate in the study. The indications for inserting EJV were same as that of IJV. Patients undergoing cardiac, intracranial, major general surgical procedures also received central venous cannulation. The inclusion criteria were elective surgery, Murali Chakravarthy*, Jayaprakash Krishnamoorthy, Seetharamji Nallam, Nagesh Kolur, Aslam Faris, Keshava Reddy, Sudheer Kumar and Simha Rajathadri Five hundred sixty three patients requiring central venous cannulation.

Conclusions: The clinicians should give a relook at alternate routes for insertion of central venous catheters. External jugular route is one of them.