[Usefulness of ultrasonographic techniques in catheterization of the internal jugular vein in patients with chronic heart failure].
BACKGROUND
The right internal jugular vein as a route for right heart catheterization and continuous infusion of drugs is increasingly used in patients with heart failure. Although this approach has several advantages, a small but definite number of unsuccessful vein punctures and/or of complications have been reported. This prospective study was designed to evaluate the usefulness of ultrasound techniques for cannulating internal jugular vein in a series of 310 consecutive patients with chronic heart failure.


METHODS
In all patients a duplex scanning of internal jugular veins was performed before the cannulation. A subgroup of 62 patients was selected for having a "difficult" cannulation according to the following criteria: previous failure of cannulating the vein (3 unsuccessful needle advances); neck abnormalities; severe emphysema and respiratory insufficiency. In these patients a Doppler-guidance system, which consisted of a miniature ultrasound Doppler transducer inserted in a standard 19 gauge needle, was used. The needle was advanced under the skin following the maximal audio signal of the venous flow. The following variables were considered: success rate, number of needle advances to cannulate the vein, time elapsed from local anesthesia and the insertion of the catheter, minor and major complications.


RESULTS
Duplex scanning showed that in 14 patients (4.5%) the right internal jugular vein was occluded or severely narrowed. In all patients the left internal jugular vein, which showed a compensatory dilatation, was successfully cannulated. In 294 of the remaining 296 patients the position of the vein was anterior to the carotid artery at a depth of 4-27 mm below the skin. With respect of the triangle formed by the two heads of the sternocleidomastoid muscle, the vein was central in 35%, medial in 15% and lateral in 60% of cases. Based on duplex scanning ultrasound data, 285 patients underwent internal jugular vein cannulation, which was achieved at the first attempt in 74% and within 3 attempts in 87% of cases. Minor and major complications occurred in 4 (1.4%) and in 1 (0.3%) respectively. By the Doppler guidance system, the cannulation was successfully achieved in 79% of patients at the first attempt and in 98% of patients (61/62) within 3 attempts. In one patient an uneventful puncture of the carotid artery occurred. The time to perform the cannulation was not significantly different using the two approaches (conventional approach: 4.4 +/- 3 minutes; Doppler guidance system: 4.2 +/- 2). Overall the internal jugular vein was successfully cannulated in 307/310 patients (99%).


CONCLUSIONS
Ultrasound techniques provide useful information which facilitates the cannulation of the internal jugular vein in patients with heart failure. The Doppler guidance method allows a rapid and safe cannulation of the vein even in cases that are difficult using the conventional approach.
Fondazione Clinica del Lavoro, IRCCS, Centro Medico di Montescano.
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Tavazzi
D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002404:Catheterization; D002405:Catheterization, Central Venous; D005260:Female; D006333:Heart Failure; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D018608:Ultrasonography, Doppler
Utilità delle tecniche ultrasonografiche nell'incannulazione della vena giugulare interna in pazienti con insufficienza cardiaca cronica.