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Journal of Trauma and Injury 2013;26(3):183-189.
Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients
Hyun Min Jeon, Sung Min Jung, Ru Bi Jung, Jin Jeon, Chong Kun Hong, Tae Yong Shin, Young Rock Ha, Young Sik Kim
1Department of Emergency Medicine, Daejin Medical Center, Bundang Jesaeng General Hospital, Korea. youngrock.ha@gmail.com
2Department of Emergency Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Korea.
외상 환자에서 초음파 유도 내경정맥 도관 삽입 시 카테터 바늘과 피부 사이의 적정 각도
전현민, 정성민, 정루비1, 전 진1, 홍종근, 신태용, 하영록, 김영식
분당제생병원 응급의학교실, 1울산의대 서울아산병원 응급의학교실
Received: 31 July 2013   • Revised: 24 August 2013   • Accepted: 2 September 2013
Abstract
PURPOSE
The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients.
METHODS
From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5< or = middle CVP < or =10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles.
RESULTS
A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68+/-0.30, 1.06+/-0.31, and 1.23+/-0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles (28.1+/-6.1, 30.1+/-4.5, and 28.0+/-5.0 degree respectively).
CONCLUSION
The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.
Key Words: Catheterization; Central vein; Intervention; Ultrasonography
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