Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% - 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.
Humans ; Male ; Adult ; Neck Injuries/diagnostic imaging* ; Wounds, Penetrating/diagnostic imaging* ; Foreign Bodies/diagnostic imaging* ; Jugular Veins ; Tomography, X-Ray Computed ; Carotid Artery Injuries/surgery* ; Carotid Artery, Common

INTRODUCTION: Totally implantable venous access devices (TIVADs) or ports are increasingly used in oncology settings to provide long-term, easy venous access. This study reports our experience and results with 1180 cases in Singapore. METHOD: Data from January 2019 to January 2022, obtained from a hospital-approved secure database application called the Research Electronic Data Capture registry, were reviewed and analysed retrospectively. RESULTS: A total of 1180 patients underwent TIVAD implantation with a 100% technical success rate. The mean age of the cohort was 61.9 years. The mean dwell duration was 342 days (standard deviation [SD] 223; range 3-1911). By 1 February 2022, 83% of patients were still using the TIVAD, 13.6 % underwent removal after completion of treatment, 2.1% were removed due to infection, 0.6% due to malfunction, 0.6% due to port extrusion and 0.1% at patient's request. The right internal jugular vein (IJV) was the most commonly accessed site (83.6%), followed by the left IJV (15.6%). The early post-procedure complications were pain (24.7%), bruising (9.2%), swelling (3.6%), bleeding (0.5%), fever (0.4%), itchiness (0.2%) and allergic dermatitis (0.1%). The delayed post-procedure complications were TIVAD site cellulitis (3.80%); discharge (1.10%); skin erosion with device extrusion (0.60%); malpositioned catheter (0.33%), which was successfully repositioned, catheter-related bloodstream infections (0.25%); migration of TIVAD leading to catheter dislodgement (0.25%); venous thrombosis (0.25%); fibrin sheath formation requiring stripping (0.10%) and TIVAD chamber inversion (0.10%). CONCLUSION TIVAD implantation via the jugular vein under radiological guidance provides a safe, reliable and convenient means of long-term venous access in oncology patients. By sharing our experience and acceptable outcomes from a large oncology cohort, we aim to increase the awareness and adoption of TIVAD usage in oncology patients, especially in Asia.
Humans ; Middle Aged ; Male ; Female ; Retrospective Studies ; Singapore/epidemiology* ; Aged ; Catheterization, Central Venous/instrumentation* ; Neoplasms/drug therapy* ; Catheters, Indwelling/adverse effects* ; Adult ; Jugular Veins/diagnostic imaging* ; Aged, 80 and over ; Catheter-Related Infections/epidemiology* ; Central Venous Catheters/adverse effects*

OBJECTIVES: To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock. METHODS: The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites. RESULTS: Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05). CONCLUSIONS In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.
Catheterization, Central Venous/adverse effects* ; Child ; Humans ; Infant ; Jugular Veins/diagnostic imaging* ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Interventional

Angiography ; Arteriovenous Shunt, Surgical ; Brachiocephalic Veins ; diagnostic imaging ; Collateral Circulation ; Constriction, Pathologic ; diagnostic imaging ; Female ; Humans ; Jugular Veins ; diagnostic imaging ; Kidney Failure, Chronic ; therapy ; Male ; Middle Aged ; Phlebography ; Renal Dialysis ; methods ; Subclavian Vein ; diagnostic imaging ; Vascular Access Devices

INTRODUCTIONWe compared the effects of various surgical positions, with and without the Valsalva manoeuvre, on the diameter of the right internal jugular vein (RIJV).

METHODSWe recruited 100 American Society of Anesthesiologists physical status class I patients aged 2-12 years. The patients' heart rate, blood pressure, peripheral oxygen saturation and end-tidal CO2 pressure were monitored. Induction of anaesthesia was done using 1% propofol 10 mg/mL and fentanyl 2 µg/kg, while maintenance was achieved with 2% sevoflurane in a mixture of 50/50 oxygen and air (administered via a laryngeal mask airway). The RIJV diameter was measured using ultrasonography when the patient was in the supine position. Thereafter, it was measured when the patient was in the supine position + Valsalva, followed by the Trendelenburg, Trendelenburg + Valsalva, reverse Trendelenburg, and reverse Trendelenburg + Valsalva positions. A 15° depression or elevation was applied for the Trendelenburg position, and an airway pressure of 20 cmH2O was applied in the Valsalva manoeuvre. During ultrasonography, the patient's head was tilted 20° to the left.

RESULTSWhen compared to the mean RIJV diameter in the supine position, the mean RIJV diameter was significantly greater in all positions (p < 0.001) except for the reverse Trendelenburg position. The greatest increase in diameter was observed in the Trendelenburg position with the Valsalva manoeuvre (p < 0.001).

CONCLUSIONIn paediatric patients, the application of the Trendelenburg position with the Valsalva manoeuvre gave the greatest increase in RIJV diameter. The reverse Trendelenburg position had no significant effect on RIJV diameter.

Anesthesia ; methods ; Child ; Child, Preschool ; Female ; Head-Down Tilt ; Humans ; Jugular Veins ; anatomy & histology ; diagnostic imaging ; Male ; Methyl Ethers ; therapeutic use ; Propofol ; therapeutic use ; Supine Position ; Ultrasonography ; Valsalva Maneuver

INTRODUCTIONWe studied the effect of head rotation on the relative position of the right common carotid artery (CCA) and the right internal jugular vein (IJV) in patients with laryngeal mask airway (LMA) insertion to evaluate the accuracy of anatomical landmarks for right IJV cannulation.

METHODSWe simulated needle insertion to the right IJV on sonograms via the central landmark approach and an approach using the external jugular vein, in patients with LMA insertion (n = 50) or endotracheal intubation (E-tube, n = 50). Overlap index and successful simulation rates were measured according to the different degrees of head rotation.

RESULTSThe overlap index between the right CCA and the right IJV increased with greater degrees of head rotation. It was significantly greater in the LMA insertion group than in the E-tube group in the following head rotation positions: neutral, 15° and 45°. The success rate of the simulation was lower in the LMA insertion group than in the E-tube group. In the LMA insertion group, the success rate of the simulation was highest (62%) with the central landmark approach and in the 15° head rotation position.

CONCLUSIONIn the LMA insertion group, the overlap index increased incrementally with greater head rotation degrees (from neutral to 45°). The central landmark approach and 15° head rotation position appear to be the optimal puncture site and degree of head rotation for right IJV cannulation in patients with LMA insertion.

Adult ; Anesthesia, General ; methods ; Carotid Artery, Common ; anatomy & histology ; diagnostic imaging ; Catheterization, Central Venous ; methods ; Computer Simulation ; Female ; Head ; diagnostic imaging ; physiology ; Humans ; Jugular Veins ; anatomy & histology ; diagnostic imaging ; Laryngeal Masks ; Male ; Middle Aged ; Needles ; Patient Positioning ; methods ; Prospective Studies ; Punctures ; Rotation ; 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

OBJECTIVETo explore the efficacy and feasibility of color Doppler flow imaging (CDFI)-guided inferior vena caval filter (IVCF) insertion through the right internal jugular vein for prevention of pulmonary embolism in patients with deep venous thrombosis (DVT).

METHODSThirty-eight patients with lower extremity DVT confirmed by clinical and CDFI examinations underwent IVCF insertion through the right internal jugular vein under guidance of CDFI for prevention of pulmonary embolism. The shape and position of IVCF were monitored by CDFI regularly. After 32 to 45 days, the retrievable filters were removed under CDFI guidance via the right internal jugular vein. All patients were followed up to monitor the occurrence of filter complications and pulmonary embolism PE.

RESULTSPreoperative CDFI clearly displayed the locations of the right internal jugular vein, inferior vena caval (IVC), bifurcation of the common iliac vein, and the bilateral renal veins in all the 38 patients. All the veins were free of anatomical variations or embolism. Under CDFI guidance, 23 retrievable IVCF and 15 permanent IVCF were placed without technical difficulty via the right internal jugular vein. Follow-up examination with CDFI and abdominal plain X-ray film showed that all the filters were placed in right positions with complete opening. The 23 retrievable filters were retrieved via the right internal jugular vein after 32-45 days. IVCF captured venous emboli in 14 cases (36.5%). None of the patients had filter displacement, tilting, or fracture or showed IVC perforation or the occurrence of pulmonary embolism.

CONCLUSIONCDFI-guided IVCF insertion via the jugular vein is safe and feasible. Compared with X-ray guidance, CDFI guidance is convenient and substantially reduces the procedural cost and avoids the risk of radiation exposure.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Jugular Veins ; surgery ; Male ; Middle Aged ; Pulmonary Embolism ; diagnostic imaging ; surgery ; Ultrasonography, Doppler, Color ; Ultrasonography, Interventional ; methods ; Vena Cava Filters ; Venous Thrombosis ; diagnostic imaging ; surgery ; Young Adult

BACKGROUNDRobotic assisted minimally invasive cardiac sugery is a new technique that uses small port sites and peripheral vessel cannulation for cardiopulmonary bypass (CPB) has been used. The right internal jugular vein (IJV) is commonly used for intraoperative venous access to the central circulation and identified with an external landmark. Previous studies have demonstrated the superiority of ultrasound guidance over external landmark technique in anaesthetic and intensive care settings. The aim of the present study was to delineate the utility of ultrasound-guided cannulation of the IJV during establishment of peripheral CPB in robotic cardiac surgery.

METHODSWe prospectively studied 296 adult patients undergoing ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery at our institute from January 2007 to October 2012 (ultrasound group). The success rate, the first attempt success rate, access time and the complication rate of ultrasound-guided method were compared with the landmark-guided method used for 302 historical control patients (landmark group).

RESULTSIn the ultrasound group, 296 consecutive adult patients underwent ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery. In the landmark group, 302 patients underwent right IJV cannulation using the landmark-guided technique. The success rate and the frst attempt success rate in the ultrasound group were significantly higher than that in the landmark group (100% vs. 88.1%, P < 0.000 and 98.6% vs. 38.4%, P < 0.000). Average access time in the ultrasound group was shorter than that in the landmark group ((6.3 ± 13.6) seconds; interquartile range (4 - 62) seconds vs. (44.5 ± 129.5) seconds; interquartile range (5 - 986) seconds). The complication rate in the ultrasound group was significantly lower than that in the landmark group (0.3% vs. 8.3%, P < 0.000).

CONCLUSIONCompared with the landmark-guided approach, ultrasound-guided cannulation of the right IJV significantly improves success rate, decreases access time and reduces complication rate during establishment of peripheral CPB in robotic cardiac surgery.

Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Cardiopulmonary Bypass ; Carotid Arteries ; diagnostic imaging ; Catheterization, Central Venous ; methods ; Female ; Humans ; Jugular Veins ; diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Robotics ; Ultrasonography, Interventional ; methods

BACKGROUNDCerebral venous sinus thrombosis (CVST) is a special form of stroke with multiple causes and risk factors. However, there are still a portion of cases with unknown reasons. The aim of this study was to investigate the relationship between internal jugular vein (IJV) abnormalities and the development of CVST.

METHODSA total of 51 CVST patients and 30 healthy controls were enrolled. The diameter, the maximum velocity (Vmax) and the reflux time in bilateral IJVs were measured by color Doppler flow imaging (CDFI). The paired t test was used to compare the numeric values between the bilateral IJVs. The Pearson chi-square test was used to evaluate the relationship between IJV abnormality and CVST, IJV abnormality and IJV reflux, respectively.

RESULTSAmong the 51 CVST patients, 20 (39%) patients were with normal IJV and 31 (61%) patients were with abnormal IJV. The types of IJV abnormality included annulus stenosis 19 cases (61%), hypoplasia 9 cases (29%), thrombosis 2 cases (7%) and anomalous valve 1 case (3%). In patients with unilateral IJV abnormality, the minimum diameter of the IJV on the lesion side was significantly smaller than that of the contralateral side (P < 0.0001). When compared with contralateral side, the Vmax of the lesion side with unilateral annulus stenosis was significant higher, however, it was obvious lower in patients with unilateral hypoplasia (P < 0.05). Furthermore, among 27 cases with unilateral IJV abnormality, all the CVST occurred on the same side as the IJV lesions.

CONCLUSIONIJV abnormality closely correlated with the development of CVST, which is a newly identified risk factor for CVST.

Adolescent ; Adult ; Female ; Humans ; Jugular Veins ; abnormalities ; diagnostic imaging ; Male ; Middle Aged ; Risk Factors ; Sinus Thrombosis, Intracranial ; etiology ; Ultrasonography