title: Cannulation needle-induced anterior wall tenting of internal jugular vein causing posterior wall penetration.
abstract: Unintentional posterior venous wall penetration during internal jugular vein (IJV) cannulation may cause critical arterial injuries in spite of ultrasound guidance. We aimed to evaluate whether small venous diameter and anterior venous wall tenting by a needle would be associated with posterior venous wall penetration, and to seek factors related to the venous wall tenting. We conducted a retrospective review in patients who underwent IJV cannulation. Using an ultrasound view obtained when puncturing, venous diameter, venous wall thickness, anterior venous wall tenting length, and needle angle were measured, and posterior venous wall penetration was determined. Eleven cannulations in 56 patients were assigned to posterior venous wall penetration. Small venous diameter (p = 0.004), and long anterior venous wall tenting (p = 0.007) were associated with posterior venous wall penetration. The longer anterior venous tenting would be expected with reducing needle angle (p = 0.004) or increasing anterior venous wall thickness (p = 0.006). In conclusion, small IJV and anterior venous wall tenting lead to posterior venous wall penetration. Anterior venous wall tenting is longer with reducing needle angle, or increasing the anterior venous wall thickness.
authors.affiliation: Department of Emergency and Disaster Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. hyoshida@cc.hirosaki-u.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Department of Emergency and Disaster Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Yaguchi
authors.affiliation: Department of Surgery, Hirosaki Chuo Hospital, Hirosaki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Itaya
authors.affiliation: Department of Cardiovascular Surgery, Aomori Municipal Hospital, Aomori, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Surgery, Hirosaki Chuo Hospital, Hirosaki, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hatanaka
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Kishiko
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures; D012189:Retrospective Studies; D014463:Ultrasonography