title: Risk factors associated with carotid artery puncture following landmark-guided internal jugular vein cannulation attempts.
abstract: OBJECTIVE
  The relationship between certain risk factors and carotid artery puncture (CAP) as an early mechanical complication following internal jugular vein cannulation attempts (IJVCAs) was evaluated.
  
  
  METHODS
  In a retrospective 1-year observational single-center study, 86 IJVCAs conducted in the operating room by 4 competent anesthesiologists were evaluated. Age, gender, puncture side, number of cannulation attempts, circumstances of the procedure and incidence of CAP were obtained from medical records.
  
  
  RESULTS
  Of the 86 IJVCAs performed in patients aged 18-75 years, CAP occurred in 8 (9.3%): 5 (5.8%) in patients >65 years and 3 (3.5%) in patients <65 years of age. CAP was not associated with patient's age (p = 0.11) and gender (p = 0.76). Multiple cannulation attempts (OR = 26.25; 95% CI = 4.52-152.51; p < 0.001) and placement of CVC under emergency conditions (OR = 14.84; 95% CI = 1.73-127.22; p = 0.014) increased the risk for CAP significantly. Also, the risk for CAP was higher when IJVCAs were performed before induction of general anesthesia (OR = 15.75; 95% CI = 1.83-135.1; p = 0.019). CAP was more likely to happen during left-sided than right-sided IJVCA (OR = 5.98; 95% CI = 1.29-27.59; p = 0.022). In addition, left-sided attempts considerably increased the risk for multiple cannulation attempts (OR = 2.782; 95% CI = 1.342-3.965; p < 0.01). Also, manifold cannulation attempts were more frequent if the IJVCA was performed before induction of anesthesia (OR = 4.219; CI = 1.579-11.271; p = 0.004).
  
  
  CONCLUSIONS
  Our results strongly suggest that left-sided, multiple IJVCAs, performed under emergency conditions in conscious patients in the operating room, represent considerable risks for possible CAP.
authors: Department of Anesthesiology and Intensive Care, School of Medicine, University of Nis, Nis, Serbia. radmilo@medfak.ni.ac.rs
authors: Radmilo J
authors: RJ
authors: Jankovic
authors: Marija S
authors: MS
authors: Pavlovic
authors: Miodrag M
authors: MM
authors: Stojanovic
authors: Biljana S
authors: BS
authors: Stosic
authors: Dragan J
authors: DJ
authors: Milic
authors: Nebojsa S
authors: NS
authors: Ignjatovic
authors: Angelina N
authors: AN
authors: Bogicevic
authors: Dragana R
authors: DR
authors: Djordjevic
authors: Nenad N
authors: NN
authors: Savic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D002339:Carotid Arteries; D020212:Carotid Artery Injuries / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D007601:Jugular Veins / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055815:Young Adult