title: The accuracy of the new landmark using respiratory jugular venodilation and direct palpation in right internal jugular vein access.
abstract: BACKGROUND
  Although ultrasonography is recommended in internal jugular vein (IJV) catheterization, the landmark-guided technique should still be considered. The central landmark using the two heads of the sternocleidomastoid muscle is widely used, but it is inaccurate for IJV access. As an alternative landmark, we investigated the accuracy of the new landmark determined by inspection of the respiratory jugular venodilation and direct IJV palpation in right IJV access by ultrasonography.
  
  
  RESULTS
  Thirty patients were enrolled. After induction of anesthesia, the central landmark was marked at the cricoid cartilage level (M1) and the alternative landmark determined by inspection of the respiratory jugular venodilation and direct palpation of IJV was also marked at the same level (M2). Using ultrasonography, the location of IJV was identified (M3) and the distance between M1 and M3 as well as between M2 and M3 were measured. The median (interquartile range) distance between the M2 and M3 was 3.5 (2.0-6.0) mm, compared to 17.5 (12.8-21.3) mm between M1 and M3. (P<0.001) The dispersion of distances between M2 and M3 was significantly smaller than between M1 and M3. (P<0.001) The visibility of respiratory jugular venodilation was associated with CVP more than 4 mmHg. Limitations of the present study are that the inter-observer variability was not investigated and that the visibility of the alternative landmark can be limited to right IJV in adults.
  
  
  CONCLUSIONS
  The alternative landmark may allow shorter distance for the right side IJV access than the central landmark and can offer advantages in right IJV catheterization when ultrasound device is unavailable.
  
  
  BACKGROUND
  Clinical Research Informational Service KCT0000812.
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Hyungseok
authors: H
authors: Seo
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Dong-Min
authors: DM
authors: Jang
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jung-Min
authors: JM
authors: Yi
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Hong-Gi
authors: HG
authors: Min
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jai-Hyun
authors: JH
authors: Hwang
mesh_terms: D000368:Aged; D000776:Anesthesiology; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods; D011446:Prospective Studies; D014463:Ultrasonography