title: Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization.
abstract: OBJECTIVE
  Artery puncture and hematoma formation are the most common immediate complications during internal jugular vein catheterization. This study was performed to assess whether the bevel-down approach of the puncture needle decreases the incidence of posterior venous wall damage and hematoma formation during internal jugular vein catheterization.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  A university-affiliated hospital.
  
  
  METHODS
  Three hundred thirty-eight patients for scheduled for thoracic surgery requiring central venous catheterization in the right internal jugular vein.
  
  
  METHODS
  Patients requiring internal jugular vein catheterization were enrolled and randomized to either the bevel-down group (n = 169) or the bevel-up group (n = 169). All patients were placed in the Trendelenburg position with the head turned to the left. After identifying the right internal jugular vein with ultrasound imaging, a double-lumen central venous catheter was inserted using the modified Seldinger technique. Venous entry of the needle was recognized by return of venous blood during needle advance or withdrawal. The internal jugular vein was assessed cross-sectionally and longitudinally after catheterization to identify any complications. A p value of <.05 was considered to be statistically significant.
  
  
  RESULTS
  There was no difference in the incidence of the puncture-on-withdrawal between the two groups (37 of 169 in the bevel-down group and 25 of 169 in the bevel-up group). However, the incidence of posterior hematoma formation was lower in the bevel-down group (six of 169 vs. 17 of 169, p = .031). Additionally, there was less incidence of the posterior hematoma formation associated with puncture-on-withdrawal in the bevel-down group (six of 37 vs. 11 of 25, p = .034).
  
  
  CONCLUSIONS
  The bevel-down approach of the right internal jugular vein may decrease the incidence of posterior venous wall damage and hematoma formation compared with the bevel-up approach, which implicates a reduced probability of carotid artery puncture with the bevel-down approach during internal jugular vein catheterization.
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Taewan
authors: T
authors: Lim
authors: Ho-Geol
authors: HG
authors: Ryu
authors: Chul-Woo
authors: CW
authors: Jung
authors: Yunseok
authors: Y
authors: Jeon
authors: Jae-Hyon
authors: JH
authors: Bahk
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control*; D006785:Hospitals, University; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013903:Thoracic Surgery / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional