title: Skin-traction method prevents the collapse of the internal jugular vein caused by an ultrasound probe in real-time ultrasound-assisted guidance.
abstract: OBJECTIVE
  Real-time ultrasound-assisted guidance for catheterization of the internal jugular vein (IJV) is known to be useful, especially for a small-sized vein, which is difficult to catheterize. However, one of the problems with real-time ultrasound-assisted guidance is that the ultrasound probe itself can collapse the vein. We have developed a novel "skintraction method (STM)", in which the puncture point of the skin over the IJV is stretched upwards with several pieces of surgical tape in the cephalad and caudal directions with the aim being to facilitate catheterization of the IJV. We examined whether this method increased the compressive force required to collapse the IJV.
  
  
  METHODS
  In ten volunteers, the compressive force required to collapse the right IJV, and the cross-sectional area and anteroposterior and transverse diameters of the IJV were measured with ultrasound imaging in the supine position (SP) with or without the STM or in the Trendelenburg position of 10 degrees head-down (TP) without the STM.
  
  
  RESULTS
  The compressive force to required to collapse the vein was increased significantly with the STM, while the crosssectional area and anteroposterior diameter of the vein in the SP with STM were similar to those in the TP without the STM.
  
  
  CONCLUSIONS
  With the STM, not only the cross-sectional area but also the compressive force required to collapse the IJV increased. Thus, the STM may facilitate real-time ultrasoundassisted guidance for catheterization of the IJV by maintaining the cross-sectional area of the vein during the guidance.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8622, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Masato
authors.initials: M
authors.lastname: Morita
authors.forename: Takafumi
authors.initials: T
authors.lastname: Azami
authors.forename: Shoji
authors.initials: S
authors.lastname: Ito
authors.forename: Nobuko
authors.initials: N
authors.lastname: Sasano
authors.forename: Rina
authors.initials: R
authors.lastname: Kato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirate
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ito
authors.forename: Akinori
authors.initials: A
authors.lastname: Takeuchi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012879:Skin Physiological Phenomena; D016683:Supine Position; D014465:Ultrasonics / Q000009:adverse effects*; D014463:Ultrasonography