title: Ultrasound-guided cannulation of the internal jugular vein in critically ill patients positioned in 30 degrees dorsal elevation.
abstract: OBJECTIVE
  Catheterization of the internal jugular vein is traditionally performed with the patient lying flat or in the Trendelenburg position. This puts patients with elevated intracranial pressure at risk of cerebral herniation. The objective of this study was to assess the safety of real-time ultrasound-guided catheterization of the internal jugular vein in ventilated patients with the patient positioned in a 30 degrees head-up position.
  
  
  METHODS
  This prospective, single-centre case series was performed in a 12-bed multi-disciplinary adult intensive care unit (ICU) in a 1500-bed university hospital. The cohort consisted of 64 ventilated ICU patients (14 female, 50 male) with a median age of 52 yr (range 18-85 yr), needing central venous cannulation for insertion of a central venous, haemodialysis or pulmonary artery catheter. The majority of patients presented with risk factors for a difficult cannulation. Catheterization was performed using real-time ultrasound guidance with all patients positioned in 30 degrees dorsal elevation.
  
  
  RESULTS
  Ultrasound-guided cannulation of the internal jugular vein was successful in all patients. There was no evidence of air embolism. Despite a high incidence of anomalous anatomy (39%) no injury to the carotid artery occurred. Central venous access was established in less than 1 min in 75% of patients.
  
  
  CONCLUSIONS
  Ultrasound-guided cannulation of the internal jugular vein in ventilated ICU patients can be performed successfully with the patient positioned in 30 degrees dorsal elevation. Potentially deleterious position changes can thus be avoided in high-risk patients.
authors.affiliation: Universitätsklinikum Würzburg, Klinik und Poliklinik für Anästhesiologie, Würzburg, Germany. brederlau_j@klinik.uni-wuerzburg.de
authors.forename: J
authors.initials: J
authors.lastname: Brederlau
authors.forename: C
authors.initials: C
authors.lastname: Greim
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.forename: B
authors.initials: B
authors.lastname: Haunschmid
authors.forename: C
authors.initials: C
authors.lastname: Markus
authors.forename: N
authors.initials: N
authors.lastname: Roewer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016683:Supine Position / Q000502:physiology; D014463:Ultrasonography