We experienced a case in which a central venous catheter (CVC) was misplaced into the wrong vein, which was mistaken for the internal jugular vein (IJV), identified by chest x-ray and ultrasound. The vertebral vein passes through the transverse foramina from the atlas to the 6th cervical vertebra. After exiting the transverse foramen of the 6th vertebra, the vein subsequently runs anterolateral to the vertebral artery and posterior to the IJV and drains the innominate vein. In this case, chest x-ray and ultrasound revealed that the inserted CVC had a course very similar to the vertebral vein. The misplacement of a CVC into the vertebral vein might occur from excessive rotation of the patient's head, which leads to alterations in the cervical vascular anatomy, and from deep insertion of the puncture needle. Therefore, it is advised, for safe CVC insertion, to minimize a patient's head rotation and to make use of ultrasound when the anatomical structures cannot be clearly identified.
Brachiocephalic Veins ; Central Venous Catheters* ; Head ; Jugular Veins ; Needles ; Punctures ; Spine ; Thorax ; Ultrasonography ; Veins* ; Vertebral Artery

PURPOSE: The internal jugular vein (IJV) is a preferred site for central cannulation for hemodialysis (HD) because of its low incidence of central vein stenosis. Although anatomically IJV is commonly located on the anterior-lateral side of the carotid artery, some patients have anatomical variation of IJV, which can lead to difficulty and complication of cannulation. This study was performed to evaMETHODS: We enrolled 358 patients receiving IJV catheter cannulation for HD using doppler ultrasonography between January 2007 and February 2009. We examined the anatomical positions of IJV in relation to the position of carotid artery (CA) and incidence of anatomical variation on both sides. We also investigated incidence of inadequate IJV for cannulation, RESULTS: The mean age of 358 enrolled patients was 57+/-15 years (14-88 years) (M:F=203:155). Anatomical variations of the left (Lt) and right (Rt) IJV position relative to the CA were found in 36.3% and 27.1%, respectively. Various anatomical variations of IJV position were discovered in the anterior side (Lt 23.7%, Rt 21.2%), anterior-medial side (Lt 7%, Rt 2.5%), and the lateral side (Lt 1.1%, Rt 1.7%) relative to CA. Inadequate Lt and Rt IJVs for cannulation, which can be too small sized or obstructed, were 6.4% and 2.8%, respectively. CONCLUSION: About one third of Korean HD patients had anatomical variations of IJV position relative to the CA. This study supports the use of doppler ultrasound guided technique for IJV cannulation in HD patients.
Carotid Arteries ; Catheterization ; Catheters ; Constriction, Pathologic ; Humans ; Incidence ; Jugular Veins ; Renal Dialysis ; Ultrasonography, Doppler ; Veins

We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Fluoroscopy ; Jugular Veins ; Needles ; Punctures ; Ultrasonography ; Veins

Internal jugular phlebectasia (IJP) is a fusiform dilatation of the internal jugular vein (IJV), usually presented as a neck mass in children. Accurate diagnosis from carefully directed history, physical examination, and radiological study could result in lifesaving therapy. We performed our study to suggest possible clinical diagnostic criteria for IJP in Korean children. We reviewed three cases of IJP (patients group) and compared the diameter of the internal jugular phlebectasias with diameters of IJVs in ten normal children (control group) using ultrasonography (USG). There were no significant differences in the range of diameters in the resting state between the two groups. The diameters on the right side, compared with those on the left side, showed no statistical significance (p < 0.05). Te range of expanding diameter and average expanding ratios (resting state to Valsalva maneuver X 100%) showed a statistical difference between the two groups (p < 0.05).
Child ; Child, Preschool ; Dilatation, Pathologic/*ultrasonography ; Female ; Human ; Jugular Veins/*ultrasonography ; Korea ; Male ; Valsalva's Maneuver

BACKGROUND: Unlike the right internal jugular vein (RIJV), there is a paucity of data regarding the effect of the Trendelenburg position on the left internal jugular vein (LIJV). The purpose of this study is to investigate the cross-sectional area (CSA) of the LIJV and RIJV and their response to the Trendelenburg position using two-dimensional ultrasound in adult subjects. METHODS: This study enrolled fifty-eight patients with American Society of Anesthesiologists physical status class I-II who were undergoing general anesthesia. CSAs of both the RIJV and LIJV were measured with a two-dimensional ultrasound in the supine position and then in a 10degrees Trendelenburg position. RESULTS: In the supine position, the transverse diameter, anteroposterior diameter, and CSA of the RIJV were significantly larger than those of the LIJV (P < 0.001). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 43 patients (74.1%), and the LIJV CSA was larger than the RIJV CSA in 15 patients (25.9%). In the Trendelenburg position, CSAs of the RIJV and LIJV increased 39.4 and 25.5%, respectively, compared with the supine position. However, RIJV changed at a rate that was significantly greater than that of the LIJV (P < 0.05). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 48 patients (82.8%), and the LIJV CSA was larger than the RIJV CSA in 10 patients (17.2%). CONCLUSIONS: In supine position, the RIJV CSA was larger than the LIJV CSA. The increased CSA in the Trendelenburg position was greater in the RIJV than the LIJV.
Adult ; Anesthesia, General ; Central Venous Catheters ; Head-Down Tilt* ; Humans ; Jugular Veins* ; Supine Position ; Ultrasonography

BACKGROUND: Measuring the distance between internal jugular vein (IJV) and external jugular vein (EJV) on ultrasound image can give the information of the whereabouts of the IJV. We compared the success rate between carotid artery (CA)-guided and EJV-guided cannulation based on the information gathered from ultrasound. METHODS: We studied 152 patients requiring central venous cannulation during anesthesia. Ultrasound images were obtained with 7.5 MHz probe on the right neck at 0 degree, 30 degrees, and maximum rotation of the head in flat and 15 degrees Trendelenberg (T) position. The horizontal diameter of the RIJV and % overlap of the CA with the RIJV at each position, and the horizontal distance of RIJV-REJV at 30 degrees were measured on ultrasound images. In EJV group, the distance of RIJV-REJV was drawn along the cricoid level and the point of IJV was marked as the needle insertion site. Cannulation was performed with palpation of the CA in CA group and performed at the marked point in EJV group without palpation of CA. RESULTS: Overall RIJV diameter was increased in T-position compared to flat position. Following head rotation, RIJV diameter was decreased and % overlap of CA was increased (P < 0.05). In 26.8% of patients at 30 degrees in T position, CA overlapped 26-50% of RIJV. The success rate of cannulation at the first trial was 97.4% in CA group and 96.1% in REJV group. CONCLUSIONS: With the IJV identified on ultrasound image, the distance between the IJV and the EJV can be used as another landmark for RIJV cannulation provided the EJV is visualized with the naked eye.
Anesthesia ; Carotid Arteries ; Catheterization* ; Head ; Humans ; Jugular Veins* ; Neck ; Needles ; Palpation ; Ultrasonography*

Internal jugular vein (IJV) thrombosis is a form of deep vein thrombosis that has a potentially fatal outcome associated with its intracranial propagation. Computed tomography and ultrasonography are useful diagnostic tools. We report a case of IJV thrombosis associated with lymphoma that was detected by carotid ultrasonography and had disappeared in follow up ultrasonography.
Fatal Outcome ; Follow-Up Studies* ; Jugular Veins* ; Lymphoma* ; Thrombosis* ; Ultrasonography* ; Venous Thrombosis

A recent widespread concept is that ultrasound-guided central venous catheter insertion is a mandatory method. Some techniques have been introduced for ultrasound-guided central venous catheterization. Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access. Therefore, we used this technique for the insertion of a large-bore cuffed tunneled dual-lumen catheter for hemodialysis. Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle. Using this approach, we can reduce the possible complications of pinching and kinking of the catheter.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Jugular Veins* ; Neck ; Punctures ; Renal Dialysis* ; Skin ; Ultrasonography

OBJECTIVE: To investigate the value of real-time ultrasound guided placement of permanent internal jugular vein (IJV) catheterization in maintenance hemodialysis patients, and analyze its technical success and complication rate. METHODS: We prospectively analyzed 63 patients (39 males, 24 females) who underwent permanent IJV cannulation with real-time ultrasound guidance from January to October in 2012. Under the real-time guidance of Logiq 5 color Doppler, we placed the tunneled cuffed catheters into the jugular vein by Seldinger technique. The number of needle punctures, technical success, the operation time, and complications were recorded. The patients were divided into a normal-risk group and a high-risk group: those who suffered multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk patients. RESULTS: Cannulation of IJV was done in all patients. Of the 63 catheters, 20 (31.7%) were placed in the high-risk patients; 60 (95.2%) were successfully placed at the first attempt, with the average number of punctures of (1.23±0.21) (range 1-3); Only 3 immediate complications (4.7%) developed; 3 (4.7%) catheter infections occurred in the course of using. Cannulation of IJV took longer time in the high-risk group than that in the normal-risk group [(30.6±0.11) min vs (19.1±0.09) min, P<0.05]. The number of needle punctures, percent of successful cannulation, and the frequency of immediate complications were similar in the high- and normal-risk groups. It was more likely to form catheter thrombosis during long-term use in the high-risk group (4/20, 20%) which might cause poor blood flow. CONCLUSION Permanent IJV cannulation under real-time ultrasound guidance is very safe with high success rates. Nephrologists can use this technique with ease and with minimal complications in both normal- and high-risk patients.
Catheterization, Central Venous ; methods ; Female ; Humans ; Jugular Veins ; diagnostic imaging ; Male ; Prospective Studies ; Renal Dialysis ; Ultrasonography

The diagnosis of internal jugular vein thrombosis (IJVT), a vascular disorder, can be easily overlooked. Disruption of blood flow through the internal jugular vein can take place in a variety of clinical settings. CT and ultrasonography are useful diagnostic tools. Recently, we experienced a case of IJVT after deep neck infection. This case showed sore throat, odynophagia and swelling of right submandibular area. CT scan revealed diffuse neck swelling and incomplete occlusion of the right internal jugular vein at the thyroid level. Treatment began with antibiotics and hydration. We present a case of IJVT after deep neck infection with literature review.
Anti-Bacterial Agents ; Diagnosis ; Jugular Veins* ; Neck* ; Pharyngitis ; Thrombosis* ; Thyroid Gland ; Tomography, X-Ray Computed ; Ultrasonography