The Study Of Ultrasound Imaging And Clinical Application Via The Lateral Border Of The Sternocleidomastoid By Internal Jugular Vein Catheterization

OBJECTIVES The aim of this study was to demonstrate the expected location of the right internal jugular vein (IJV) by ultrasound imaging, in order to find the optimal access via the lateral border of the sternocleidomastoid, and to evaluate it prospectively by clinical practice.METHODS There were two parts in this study. In the first part, 80 adults were enrolled. By three head positions and three anatomic levels, we analyzed the overlap of the right IJV and the common carotid artery (CCA) by ultrasound imaging technique, and measured the inner diameters of the right IJV and the distances from the right IJV to the skin of the lateral border of the sternocleidomastoid. After analyzing the information, we found the optimal access for the right IJV catheterization by the lateral border of the sternocleidomastoid.In the second part, a total of 180 patients, ASA physical statusⅠ～Ⅱ, scheduled to undergo routine surgery under endotracheal anesthesia and required IJV cannulation were randomly assigned to two groups, 90 cases in each group. Patients in the test group were catheterized via the optimal approach by the lateral border of the sternocleidomastoid which was found by ultrasound imaging, and the control group via the apex of the triangle formed by the two heads of the sternocleidomastoid and clavicle. The distances from the skin of puncture point to IJV, the success rate of first-time catheter placement, the success time of first-time catheterization, and the occurrence of related complications were recorded. RESULTS The first part (the ultrasound imaging study): At the head rotation of 30°, the overlap of the right IJV and the CCA was the highest at the level of the superior border of the thyroid cartilage, which was significantly higher than the level of the cricoid cartilage or the seventh cervical vertebra (P<0.01); at the level of the cricoid cartilage and the level of the seventh cervical vertebra, both of the inner diameters of the right IJV were bigger, which were compared with the superior border of the thyroid cartilage level (P<0.05); the distance from the lateral border of the IJV to the skin of the lateral border of the sternocleidomastoid, which was deepest at the level of the superior border of the thyroid cartilage, was deeper than the other two levels (P<0.05). At the head rotated 45°to the left, when compared the overlap of the right IJV and the CCA, at the level of the superior border of the thyroid cartilage was significantly higher than the level of the cricoid cartilage or the seventh cervical vertebra (P<0.01); at the levels of the cricoid cartilage and the seventh cervical vertebra, both of the inner diameters of the right IJV were bigger, which were compared with the superior border of the thyroid cartilage level (P<0.05); the distance from the lateral border of the IJV to the skin of the lateral border of the sternocleidomastoid, which was deepest at the level of the superior border of the thyroid cartilage, which was deeper than the level of the seventh cervical vertebra (P<0.05).At the level of the cricoid cartilage or the seventh cervical vertebra, the inner diameters of the right IJV and the overlap of the right IJV and the CCA showed no difference when the head turned 0°,30°,45°to the left (P>0.05);when the head turned 0°to the left,the distances from the lateral border of the IJV to the skin of the lateral border of the sternocleidomastoid were different, which were compared to the head rotation of 30°or 45°(P<0.05).The second part (the clinical study): To compare the two groups, the rate of successful first pass catheterisation of IJV was higher in the test group (P<0.05), which was accompanied by a shorter success time (P<0.05). The occurrence of artery puncture and hematoma complications showed statistically different in favor of the test group (P<0.05). The distances of the skin of puncture point to IJV showed no difference between the two groups (P>0.05).CONCLUSIONS The optimal access for the right IJV catheterization by the lateral border of the sternocleidomastoid was the head turned to the left 30°～45°, from the level of the cricoid cartilage to the level of the seventh cervical vertebra. The optimal approach for right IJV catheterization by the lateral border of the sternocleidomastoid was superior than the approach via the triangle top of the sternocleidomastoid, which could be used in clinical practice.