title: Prospective evaluation of ultrasound-guided short catheter placement in internal jugular veins of difficult venous access patients.
abstract: BACKGROUND
  Difficult vascular access (DVA) is a common problem. Placement of ultrasound-guided standard length catheters (ultrasound-guided peripheral intravenous [USPIV]) in the internal jugular (IJ) vein is a potential solution.
  
  
  OBJECTIVE
  The objective of the study is to evaluate the immediate and short-term incidence of complications after USPIV placement in IJ of DVA patients.
  
  
  METHODS
  We conducted a prospective convenience study of USPIV into IJ of emergency department patients with DVA. All USPIV placements were performed with standard aseptic techniques with either an 18-gauge 6.35-cm single-lumen catheter or 20-gauge 5.7-cm catheter. Immediate complications were evaluated. Clinical follow-up consisted of review of the electronic medical record for physician and nursing documentation, laboratory data, and imaging studies in a multiple hospital network. Outcome measures 1 and 6 weeks included local site abnormalities, bleeding, local or systemic infection, pneumothorax, or thrombosis at time of placement, and death.
  
  
  RESULTS
  We enrolled 33 patients (58% female; mean age, 56.4 years; and median body mass index of 24.7). Eleven physicians performed USPIV placement. Median access time was 4.0 (interquartile range, 5.5) minutes and 1 attempt for placements. There were no immediate complications. Follow-up was successful in 5 of 7 discharged patients and 26 of 27 admitted patients. Three deaths within 6 weeks were unrelated to USPIV. Three patients lost to follow-up were not discovered on electronic medical record or death registries. No patient had catheter-related complications.
  
  
  CONCLUSIONS
  There were no immediate or short-term complications associated with aseptic USPIV placement into IJ. Ultrasound-guided peripheral intravenous IJ placement was a rapid and safe approach in DVA patients.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. Electronic address: Davidkiefer1@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Kiefer
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. Electronic address: Stephen.Michael.Keller@gmail.com.
authors.forename: S Michael
authors.initials: SM
authors.lastname: Keller
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. Electronic address: Anthony.Weekes1@gmail.com.
authors.forename: Anthony
authors.initials: A
authors.lastname: Weekes
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011446:Prospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional