Comparison The Clinical Application Of Short And Oblique Axis Ultrasound-guided Internal Jugular Vein Puncture And Catheterization In Patients With Short Neck

Background: Internal jugular vein(IJV)catheterization is the most commonly used method to establish deep vein access in the department of anesthesiology.Routinely,the localization of IJV puncture and catheterization relies on sternocleidomastoid muscle anatomical localization and arterial palpation,however,it will be difficult and prone to mechanical complications in case of the patient with anatomic variation,obesity,and short neck,etc.At present,ultrasound-guided IJV catheterization is widely used in medical practice.According to relevant studies reported by domestic and foreign scholars,the standard use of ultrasound-guided IJV puncture catheterization has the advantage of effectively reducing various complications caused by puncture on the one hand and greatly improving the success rate of the first puncture.There are three methods of ultrasound-guided IJV puncture and catheterization,which are short,long and oblique axis methods.Studies have confirmed that the long axis method has some limitations in special patients,for instance patients with short neck,due to the limitation of the length of the ultrasonic probe.Previous studies included patients with moderate neck length suitable for all kinds of ultrasound-guided IJV puncture,while clinical studies on the merits of ultrasound-guided IJV puncture in special patients with short and oblique axis are still lacking in sufficient clinical evidence,which urgently needs to be researched.Objective: To compare the clinical application of ultrasound-guided IJV puncture and catheterization by short and oblique axis methods in patients with short neck,and to explore the most suitable ultrasound guidance method for IJV puncture and catheterization in patients with short neck.Method: A total of 120 short neck patients,from November 2017 to June 2018,scheduled for elective surgery under general anesthesia,as well as IJV puncture and catheterization were enrolled.Participants were randomly assigned to the short axis method group(n=60)and the oblique axis method group(n=60).The adjacent relation between the short axis plane and oblique axis plane IJV and common carotid artery(CCA)was observed and compared,and ultrasonic images were collected.Then,the right IJV was chosen for puncture and catheterization with the short axis method or the oblique axis method under the guidance of ultrasound according to the randomization.The puncture times,the first puncture success rate,the time of IJV puncture,the total time of puncture and catheterization,and the occurrence of puncture complications were recorded in the two groups.The adjacent relation between IJV and CCA of the short axis plane and the oblique axis plane was recorded,respectively.The transverse diameter of IJV of the short axis plane and the overlapping distance between IJV and CCA was measured,and the overlapping rate of IJV and CCA was calculated.Result: Compared to the short axis method group,the number of punctures in the oblique axis method group was obviously less than that in the short axis method group,and the success rate of one puncture was obviously higher than that in the short axis method group(P < 0.05);the IJV puncture time and total time of puncture and catheterization with the oblique axis method group were obviously shorter than that of the short axis method group(P < 0.05).The incidence of malocclusion in the oblique axis method group was obviously lower than that in the short axis method group(P < 0.05),however,the incidence of local hematoma was similar between the two groups(P > 0.05).The adjacent relation between IJV and CCA on oblique axis and short axis plane is different.Compared to the short axis plane,the transverse diameter and safe puncture distance of oblique and short axis plane is increased,the overlapping distance between IJV and CCA is significantly decreased,and the overlap rate between IJV and CCA is obviously reduced in the short axis plane(P < 0.01).Conclusion: For short neck patients,ultrasound-guided IJV puncture and catheterization is adopted,and the oblique axis method is superior to the short axis method,which can obviously shorten the operation time,reduce the number of puncture times,reduce the overlap rate between IJV and CCA,as well as increase the safe puncture distance and effectively reduce various complications caused by puncture.