Ashok Kumar, A (2008) A Comparison of Right and Left Sided Internal Jugular Venous Cannulation by the Traditional Blind Anatomic Landmark Technique. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Central Venous access is essential part of patient management in many clinical settings. Central Venous catheters are used for hemodynamic monitoring, giving vasopressors, cytotoxic drugs, blood sampling and transfusion of blood products, preoperative intravenous fluid infusion and parenteral nutrition. Central Venous cannulation is performed in a wide range of locations within the hospital as an elective or emergency procedure. Central Venous access is commonly attempted at the internal jugular vein, subclavian vein, femoral vein or arm veins using peripherally inserted central catheters. The actual site chosen in a particular patient should vary based on the indication, individual institutional and operator experiences. In most preoperative patients, IJV is the best route because of it’s reliability and low rate of major complications with insertion. There are various techniques for placing central venous catheters in IJV. The standard conventional technique for placing central venous catheters in IJV is by using anatomical landmarks. The right internal jugular vein is usually chosen for many reasons. But, in cases like penetrating injuries on the left side of chest, left side hydropneumothorax, etc., left internal jugular venous cannulation is preferable. The anatomical relations, course dimensions of left internal jugular vein differ from right internal jugular vein. Hence it is very important to compare the success rate, complications and depth of right and left internal jugular venous cannulation. AIMS OF THE STUDY: The purpose of this study was to compare right and left internal jugular venous cannulation by traditional blind anatomic landmark technique for placement of central venous catheter in patients posted for major elective cardiac surgeries in terms of the following parameters: 1. The time taken to locate the IJV with pilot needle, 2. The time taken to locate the IJV with 18 G needle, 3. Number of attempts required for successful guide wire insertion, 4. Depth of cannulation, 5. The total access time, 6. The success rate and failure rate and 7. Incidence of complications. MATERIALS AND METHODS: Study Design: This study was conducted in cardio thoracic operation theatre at the Government General Hospital, Chennai between May 2007 and August 2007 on forty patients posted for elective major cardiac surgery. This study was done after institutional approval and written informed constant was obtained from all the patients included in this study. This study was done in a prospective randomized manner. Forty patients of either sex posted for major elective cardiac surgeries satisfying the selection criteria were randomly allocated into the two groups (Group R and Group L). Group R: Patients in this group underwent right sided internal jugular venous cannulation by central approach of traditional blind anatomic landmark technique. Group L: patients in this group underwent left sided internal jugular venous cannulation by central approach of traditional blind anatomic landmark technique. Materials Used: The triple lumen central venous catheter (20 cm – Length) manufactured by Arrow company were used for cannulation on both right and left side by anatomic landmark technique. Selection of cases: Inclusion criteria: 1. Age – 15 to 60 Years, 2. Elective IJV cannulation. Exclusion Criteria: 1. Emergency cannulation, 2. Coagulopathy, 3. Neck deformities, 4. Local sepsis, 5. H/O i.v drug abuse, 6. H/O IJV thrombosis. Preanaesthetic Evaluation: Patients included in this study underwent thorough preoperative evaluation which included history, detailed physical examination and investigation. OBSERVATIONS AND RESULTS: Forty patients of either sex posted for major elective cardiac surgeries satisfying the selection criteria were randomly allocated into two groups. (Group R, Group L – 20 patients each). Group R: Patients in this group underwent right sided internal jugular venous cannulation by central approach of traditional blind anatomic landmark technique. Group L: Patients in this group underwent left sided internal jugular venous cannulation by central approach of traditional blind anatomic landmark technique. SUMMARY: In this study comparing the right sided and left sided internal jugular venous cannulation by the traditional blind anatomic landmark technique, the following parameters have been observed and statistically analyzed: the time taken with the pilot needle to locate the IJV, the time taken with 18 G needle to locate the IJV, the number of attempts for successful guidewire insertion, the total access time, depth of cannulation, the success rate, the failure rate and the complication rate. 1. The mean time taken with the pilot needle to locate the IJV in, Group R – 9.40 +/- 1.095 sec, Group L – 9.75 +/- 2.124 sec. There is reduction in time taken to locate the IJV in group R. 2. The mean time taken with 18 G needle to locate the IJV in, Group R – 10.1 +/- 0.968 sec, Group C – 11.55 +/- 2.064 sec. Significant reduction in time taken to locate the IJV with 18 G needle in Group R. 3. Mean number of attempts for successful guidewire insertion in Group R – 1.0, Group L – 1.5 +/- 0.688. Significant reduction in the number of attempts required for successful guide wire insertion in Group R. 4. The mean total access time in Group R – 282.35 +/- 56.784 sec, Group L – 334.85 +/- 93.514 sec. Significant reduction in the total access time in Group R. 5. The mean depth of cannulation in, Group R – 14.89 +/- 0.880 cm, Group L – 17.33 +/- 1.582 cm. The depth is significantly less for Group R. 6. Successful cannulation at first attempt in Group R – 14/20 – 70%, Group L – 5/20 – 25%. Significant reduction in the number of attempts required for successful cannulation in Group R. 7. Failure rate: Group R – 0%, Group L – 20%. There was a reduction in failure rate in Group R. 8. Complication rate: a) Carotid artery puncture rate: Group R – 0%, Group L – 25%. b) Hematoma rate: Group R – 0%, Group L – 25%. There was a reduction in complication rate in Group R. CONCLUSION: Right sided internal jugular venous cannulation is better compared to left sided internal jugular venous cannulation because the access time is less( time taken to locate with pilot needle, time taken to locate with 18G needle and total access time), insertion of guidewire at first attempt is excellent, depth of cannulation is less and failure rate is nil with no complications.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparison ; Right and Left Sided Internal Jugular ; Cannulation ; Traditional Blind Anatomic Landmark Technique. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 21 Apr 2018 08:44 |
| Last Modified: | 21 Apr 2018 08:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7186 |
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