Trouble shooting a small sized IJV - JCCCM
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Central venous cannulation (CVC) is an important procedure in the practice of anesthesiology and emergency medicine. Central venous catheters are needed for the administration of fluids, blood products, and vasoactive drugs and for transvenous cardiac pacing and hemodynamic monitoring. The use of ultrasound facilitates the visualization of the various anatomical variations of the internal jugular vein (IJV) with regard to the size and the relation of the IJV with the carotid artery. This has improved the success rates and decreased the complications with IJV cannulations. A 30-year-old male with severe septic shock and disseminated intravascular coagulopathy was placed supine with 15° down Trendelenburg position and 30°-45° neck rotation toward contralateral side. A portable ultrasound "SonoSite Micromaxx" machine with 7.5 MHz linear array (vascular) probe was used. The probe was placed in sagittal plane at the level of cricoid cartilage to obtain short axis view of the IJV. The cross-sectional diameter of IJV was <0.7 cm. The probe was thus moved caudally and then rotated to obtain semi-axial view of IJV merging with the subclavian vein (SCV) just above the sternoclavicular articulation. This point corresponds to the "Pirogoff's confluence" from where the brachiocephalic vein (BCV) arises. CVC was thus successfully performed after the single attempt of puncture of the confluence of the three veins; IJV, SCV, and BCV...

http://bit.ly/2q3MyfK
Like
Comment
Share