PURPOSE: The purpose of this study is to encourage the use of real-time sonography during central venous cannulation in the cervico-thoracic location as a routine procedure devoid of serious complications during elective and emergency proceedings in stable and unstable patients, in complex and critical conditions.
METHODS: The conditions encountered included the following: active cardiac arrest, acute-on-chronic congestive heart failure, renal failure, respiratory failure/insufficiency, hypocoagulability, (thrombocytopenia, elevated PTT, PT, INR), morbid obesity, hypovolemia, sepsis, leukopenia, neutropenia, upright position with severe COPD, contra- or ipsilateral pneumothorax/hemothorax, venous thrombosis, high-PEEP settings, high-risk surgeries in need of central venous access. Some of these conditions formerly merited relative or absolute contraindications with subclavian and jugular approach, and definitely with the “convergent” method. During venous access, the anatomic relation of vein to artery is kept. In the short-axis view, the internal jugular vein is anterior to the common carotid artery. The subclavian vein is above the subclavian artery in the supraclavicular or infraclavicular approach. The right “convergent” vein consists of the junction of the right internal jugular vein to the right subclavian vein as they form the superior vena cava. The left “convergent” vein is the junction of the left internal jugular vein to the left subclavian vein as they join to form the innominate vein.
RESULTS: All patients with purported absolute or relative contraindications were granted internal jugular access. Nearly all were successfully cannulated without any arterial, pleural, or pulmonary complications.
CONCLUSIONS: The aim is to safely offer a “one-time, one-pass, one entry” technique via real-time sonography as a new goal to encourage 90% + for 2-needle-passage and 95%+ success for one needle-passage regardless of the patient’s clinical status.
CLINICAL IMPLICATIONS: In contrast to the “blind” technique, the sonographic identification of the vein minimizes the frequency of perivenous punctures, and reduces not only soft tissue infiltration and swelling, but also pleuro-pulmonary and arterial complications, while using new techniques for safer access.
DISCLOSURE: The following authors have nothing to disclose: Albert Olivier
The "convergent" technique applies to the junction of the internal jugular vein to the subclavian vein as they help form the superior vena cava on the right, and the innominate vein on the left.