Respiratory jugular venodilation: a new landmark for right internal jugular vein puncture in ventilated patients.

OBJECTIVE: To report a new technique for right internal jugular vein puncture using respiratory jugular venodilation as a landmark for vein location.

DESIGN: Prospective observational study.

SETTING: Single community hospital.

PARTICIPANTS: Two hundred patients undergoing right internal jugular vein cannulation under general anesthesia.

INTERVENTIONS: Catheter placement was attempted using respiratory jugular venodilation as the primary landmark. When it was not applicable, an alternative technique using the carotid pulse as a landmark was used.

MEASUREMENTS AND MAIN RESULTS: Visibility of the venodilation, the number of needle passes, the success rate, and the incidence of arterial puncture were analyzed. Respiratory jugular venodilation was observed in 158 patients (79%). In this group of patients, the jugular vein was cannulated at the first attempt in 83.5% of patients, and arterial puncture occurred in one patient (0.6%). In the remaining 42 patients (21%) lacking the visible venodilation, catheter placement was accomplished at the first attempt in 42.9% of patients (p<0.01 v. the venodilation-visible group), and 4 patients (9.5%) suffered arterial puncture (p<0.01). The overall incidence of arterial puncture was 2.5%. The success rate of cannulation (within four needle passes and no arterial puncture) was 98.1% in the venodilation-visible patients and 73.8% in the others (p<0.01), with the overall success rate of 93%.

CONCLUSIONS: Respiratory jugular venodilation can be identified in a large proportion of ventilated patients. This experience suggests that respiratory jugular venodilation could be favorably used as the primary landmark for right internal jugular vein puncture in anesthetized patients.