The "medial-oblique" approach to ultrasound-guided central venous cannulation--maximize the view, minimize the risk.
Carotid puncture and insertion of a large-bore catheter into the carotid artery is a feared complication associated with internal jugular vein (IJV) cannulation. The use of ultrasound with real-time imaging of the neck vessels during needle insertion has the potential to decrease the incidence of serious complications associated with central venous access. The authors describe a new technique for ultrasound-guided IJV cannulation. The suggested "medial-oblique" approach allows for optimal imaging of the IJV and the carotid artery side by side and following the needle throughout the insertion from skin to vessel penetration in a medial-cephalad to lateral-caudad direction. This technique combines the advantages of the short-axis and long-axis approaches and minimizes the risk of carotid puncture from a medial-to-lateral needle direction.
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
Ralph
R
Dilisio
Alexander J C
AJ
Mittnacht
D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*