Thank you to all our blog readers and subscribers who followed our posts in 2013. We will continue to deliver interesting stories and educational content in 2014. Our most read post of the year was an excerpt about vascular access line placement from Dr. Brian Pollard’s e-book “Ultrasound Guidance for Vascular Access an Regional Anesthesia.” Stay tuned for more anesthesia ultrasound posts from Dr. Pollard and other authors in 2014.
Thank you to all our blog readers and subscribers who followed our posts in 2013. We will continue to deliver interesting stories and educational content in 2014.
Our most read post of the year was an excerpt about vascular access line placement from Dr. Brian Pollard’s e-book “Ultrasound Guidance for Vascular Access an Regional Anesthesia.” Stay tuned for more anesthesia ultrasound posts from Dr. Pollard and other authors in 2014.
The Internal Jugular Vein (IJV) is commonly selected by anesthesiologists for central access because its anatomical position relative to surface and deep structures is well established. In his book, Ultrasound Guidance for Vascular Access and Regional Anesthesia, Dr. Brian Pollard demonstrates ultrasound-guided vascular access line placement using the IVJ.
Here is an excerpt from the book:
On ultrasound short-axis imaging the IJV appears as a hypoechoic structure that is typically slightly irregular in shape, and lies lateral to the smaller and rounder carotid artery in the neck. There are many hypoechoic round structures in this field (including the nerves of the brachial plexus), and both carotid artery and IJV are frequently pulsatile. Therefore, definitive identification of this structure requires Colour Doppler or Colour Power Doppler assessment to identify characteristics of flow, and then further distinction between artery and vein using Spectral Wave form analysis.
Known anatomical surface relationships and fundamental scanning techniques allow the transducer to be transversely oriented over the anticipated IJV territory of the neck. Initial ‘scout’ scans will reveal the sternocleidomastoid superficially, and two deeper hypoechoic structures of varying diameter, shape, compressibility, and pulsatility. Using Doppler techniques the anatomical position of the carotid artery and IJV are identified on the ultrasound screen image. With a confirmed identification of carotid artery and IJV, the IJV is optimally visualized in the centre of the screen and then may be approached using either an In-Plane or Out-of-Plane needle technique.
The In-Plane vascular access approach to the IJV requires a longitudinal view of the vessel. Once clearly establishing the IJV in short axis, rotate the transducer through 90 degrees to capture the vein in long axis (be careful not to lose the vessel in the field of view). If the vessel image is lost, return to the short axis view for confirmation once again before rotating to the long-axis view. Note that it may be difficult to capture colour Doppler or Spectral Waveform Doppler analysis in the long axis view because the transducer often rests perpendicular to the flow of blood. With the optimal ultrasound image of the defined vessel achieved, engage the GPS function to enable needle navigation and bring the vascular access needle to rest on the skin.
Download the entire E-Book to learn more about using ultrasound guidance for vascular access.