Obtaining external jugular venous access in the prone-positi
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The anesthesiologist is more than occasionally confronted with having to obtain or “augment” intravenous (IV) access. This frequently occurs with changes in patient positioning. Moreover, “tucking” or adduction of the arms may create “resistance” and additionally interfere with the appropriate flow of IV fluids. Existing IV access may also “clot off” or infiltrate; despite previously working successfully.

Once in the prone position, the ability to obtain additional IV access can be challenging. The authors have utilized the external jugular vein (EJV) under these circumstances with relative ease [Figure 1]. On two occasions, EJV cannulation was achieved quickly. Furthermore, enough “backflow” was available to allow for venous blood gas assessment. Use of ultrasound guidance (USG) may also be beneficial to locate the vessel. In each of the two instances, the patients' arms were covered with padding and adducted. In addition, extensive hospitalization, obesity, and IV drug abuse made localization for peripheral venous access unobtainable; despite untucking of the patients' arms and employing USG and infrared-based optical devices....

http://www.joacp.org/article.asp?issn=0970-9185;year=2017;volume=33;issue=1;spage=124;epage=125;aulast=Atlas
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