ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 1343 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    Article Figures

 Article Access Statistics
    Viewed751    
    Printed8    
    Emailed0    
    PDF Downloaded185    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
VIDEO COMMENTARY  
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 142
Approaches to internal jugular and subclavian vein


Department of Cardiac Anaesthesia, CNC, AIIMS - New Delhi, India

Click here for correspondence address and email

Date of Web Publication31-Dec-2015
 

How to cite this article:
Irpachi K, Hasija S, Malhotra P. Approaches to internal jugular and subclavian vein. Ann Card Anaesth 2016;19:142

How to cite this URL:
Irpachi K, Hasija S, Malhotra P. Approaches to internal jugular and subclavian vein. Ann Card Anaesth [serial online] 2016 [cited 2020 Apr 4];19:142. Available from: http://www.annals.in/text.asp?2016/19/1/142/173031


Middle Approach (Video 1)[Figure 1]
Figure 1

Click here to view


Advantages:

More reliable landmark when carotid pulsation is weak or absent

Low risk of pleural puncture

It is visible and easily compressible if a hematoma forms in the neck

Disadvantages:

IJV may collapse in the hypovolemic patients

It is more uncomfortable for patient than the subclavian route and may

dislodge or kink as a result of neck movement

Failure rate is higher with internal jugular than with subclavian route

Anterior (High) Approach (Video 2) Advantages:[Figure 2]
Figure 2

Click here to view


It offers the easiest route with a low risk of complications Semipermanent tunneled central line is preferred. Disadvantages: Higher rate of carotid puncture and haematoma formation.

Posterior (Low) Approach (Video 3) [Figure 3]
Figure 3

Click here to view


Advantages:

Posterior approach permits easier threading than anterior approach

Subjective discomfort on neck movement less by posterior approach, as the cannula not anchored to the muscle

Posterior approach provides a safe alternative route in patients like short necked, obese, critically ill, patients on tracheostomy, and pathology in lower part of the neck. Disadvantages:

Injury to the ascending cervical artery, extrapleural haematoma and lateral hemothorax may occur. Infraclavicular Approach (Video 4)[Figure 4]
Figure 4

Click here to view


Advantages:

Relative advantage over the internal jugular approach for patients with shock neck.

Disadvantages:

Kinking of catheter occurs more frequently because of infraclavicular course.

Supraclavicular Approach (Video 5) I Advantages: Easy access during anesthesia Large target vein Low infection risk [Figure 5]
Figure 5

Click here to view


Suitability for subcutaneous tunnelling and port access Disadvantages:

Vessel lies very close to innominate artery Higher bleeding risk Higher risk of pneumothorax

'Blind' procedure that cannot be guided with ultrasound Increased risk of an injury to thoracic duct during left sided approach






Top
Correspondence Address:
Kalpna Irpachi
Department of Cardiac Anaesthesia, CNC, AIIMS - New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 26750685

Rights and PermissionsRights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top