Internal jugular vein!

Internal jugular vein

Internal jugular vein! 

In neurological patients with aumentation of intracranial pressure we often chose subclavian vein

Hi,

as for me I prefer subclavian vein as it is the most comfortable for the patient and has the least rate of infection. However, I am one of the rare who does it - it is not very easy to perform it with ultrasound. I insert CVC more peripherally (not directly under the clavicle). The majority of my colleagues does it on the internal jugular vein. As for PICC I use basilic vein - all with ultrasound.

Femoral vein is mostly used in small children.

Internal jugular vein

I prefer subclavian vein

Our institution used the internal jugular most often

Internal jugular vein

I know that many clinicians prefer to perfom US access to the internal jugular vein as they consider the subclavian US approach to be more difficult (actually axillary as it is more lateral). But as the latter is recommended for easier management and lower infection rate, it would be interesting to evaluate the overall risk/benefit ratio of both techniques with US guidance. Would anyone like to study this topic?

Internal jugular vein for most patients. But sometimes , for ex congenital chylothorax, i prefer femoral vein. 

Ivan,

My plans are to start such a study this year. I would like to compare US-guided internal jugular and axillary vein approach. It will be RCT of course. Multi-center study would be much better option. If anyone is interesting to participate please do not hesitate to contact me.

In our institution internal jugular access via US guide is more popular  cause it has better and sooner outcome besides less complications.

Tomasz,

I'd be glad to develop a study protocol on this topic or to participate if it's already been prepared. In my opinion, one concern could be reproducibility of the technique (as it's not yet standardised) and inter-operator variability (as only few colleagues consider the axillary approach to be simple). After more than 10 years of US guided central venous access I may have a personal bias but I find it quite easy. Please feel free to contact me when you can! [email protected]

Am I surprized?

How can one have a standard location for central venous cannulation?

Central venous catheters come in a variety of lengths, gauges, composition, and lumen number. These  vary according to the purpose of the catheterization, whether for CVP monitoring or other therapeutic indications and whether intended for short- or long-term use.

However, Seven-French, 20-cm multiport catheters that allow monitoring of CVP and infusion of drugs and fluids simultaneously are the most common. 

Selecting the best site for safe and effective CVC ultimately requires consideration of the indication for catheterization (pressure monitoring versus drug or fluid administration), the patient’s underlying medical condition, the clinical setting, and the skill and experience of the physician performing the procedure.

Refer page 1285, Miller's Anesthesia, 7th Edition.

-Parimal

dear tomasz

subclavian 

These days, the majority of my central lines are for long term use, and therefore, I prefer the subclavian route.  Venous access via the subclavian access is much less bothersome to the awake patient, and because of very little movement around the insertion point, the dressings stay undisturbed and clean much longer.  The result is a sharp reduction in catheter infection.

Subclavian is the preferred in my unit and all my patients will have subclavian line as the first choice

Subclavian and femoral are my personal choices. As mentioned by other doctors too, there is less disturbance to SCV lines as there is less movement.

I would definitely use USG while canulating IJV as it reduces unnecessary pricks. 

In our institution internal jugular access via US guide is the standard approach

all central venous access, but mainly subclavian route

In our PICU, initially when we started US guidance for CVS about 5 years back, it was mainly IJ, but as the Team mastered USG more & became familiar with the more challenging femoral site in this age group, currently it's almost equal between IJ & Femoral veins. 

I second your suggestions for RCT, and if there is a Pediatric Subgroup for such RCT, will be happy to help.. It would be interesting exploring Adults versus Pediatric ICU practices. 

In our pediatric cardiac surgery unit , we use the ultrasound for internal jagular vein catheterization .. usually we don't use the ultrasound for the femoral vein

In our NICU, we prefer subclavian vein without using the ultrasound when we perform central venous catheterization.

In our Adult ICU, we usually perform US-guided internal jugular vein catheterization.

In our adult ICU we prefer US guided internal jugular access,although we also use US guided femoral access when required.

In paediatric emergencies we would usually use the femoral approach,given that it is easier and safer in a non-specialist centre.

We rarely use the subclavian approach,even with US guidance as the potential complication rate is not only higher,but also may be more difficult to manage.

We prefer to place transcutaneous catheters in newborns. We also use all venous accesses, depending on the disease. For a newborn with gastroschisis, we often place an internal or external jugular vein. For diaphragmatic hernia, we catheterize the femoral vein. All catheters are installed under ultrasound control. For older children, we use the internal jugular vein first.

I prefer USG guided IJV ...

In our institution we use US guided IJ, but our surgeons frequently place subclavian central lines which is my favorite.

By far, most of my colleagues, use the Internal Jugular Vein (R >> G) approach, for the Installation of a Central Vein Catheter. That being said, I, personnally, was trained 30 years ago. Therefore, at that time; the Sub-Clavian approach (Without Ultrasound), was, and by far, the mostly taught and utilized Central Vein Catheter Installation approach. Therefore, I have decided to continue to use this technical procedure. There are pros & cons, between Sub-Clavian(SC) & Jugular(J): SC: Pros/Less Catheter Sepsis, less CVC Phlebitis, ĺess Intra-Cranial Hypertension Episodes /// Cons/Even with many years of experience, there is a lower rate of success; and finally a Significantly Higher Risk of Pneumothorax. Still, my colleagues are sometimes glad that the "Olď Man" always kept his skills to install a Sub- Clavian Catheter, whenever they need this very access, because of whatever reason you may think of!!... // Jean-Francois MATHIEU, MD, MSc, LMCC