John Oropello, MD, FCCM
Professor of Surgery and Medicine, Institute of Critical Care Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Atinuke Shittu, M.B.B.S, MPH
Senior Clinical Research Coordinator, Institute of Critical Care Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Roopa Kohli-Seth, MD, FCCP, FACP
Director of the Institute for Critical Care Medicine
Mount Sinai Health System
New York, NY
Disclosure information not submitted.
Title: Internal Jugular Mid-vein and Posterior Wall Depth during Central Line Placement using Ultrasound
Introduction: The internal jugular (IJ) vein is the most commonly accessed central line placement site. Complications including pneumothorax and inadvertent arterial puncture are related to the depth of introducer needle insertion. There is no published data about the depth of the IJ vein during central line placement under ultrasound (US).
Methods: Retrospective, non-randomized analysis of stored US images taken in real time during IJ vein central line placement in Trendelenburg position (TP) from 12/01/2016 to 11/30/2019. Distance from skin to IJ mid-vein and IJ posterior wall was measured. Data on gender and BMI were collected.
Results: 608 images were analyzed. 233 images were poor quality and discarded. 375 were suitable, 35% female, 65% male. Average skin to IJ mid-vein depth was 14.81mm +/- 3.64SD, range 8-27mm (female 14.74mm +/- 3.7SD range 8-26mm; male 14.85mm +/- 3.57SD range 8-27mm). Average skin to IJ posterior wall depth was 20.83mm +/- 4.85SD range 12-36mm (female 20.71mm +/- 5.00SD range 12mm-36mm; male 20.90mm +/- 4.72SD range 13-33mm). Skin to IJ vein depths were normally distributed with similar standard deviations when compared for discrete genders or total population. Multivariate regression analysis was used to investigate relationships between gender, BMI and skin to IJ vein depth. Adjusting for BMI, male skin to IJ mid-vein depth was 2mm deeper and skin to IJ posterior vein depth was 1.2 mm deeper compared to females.
Conclusions: Previous studies using computed tomography (CT) focus on the relationship between the IJ vein and carotid artery, but not IJ vein depth. In addition, CT images were not recorded during central line insertion or in TP. The average sonographic distance to reach the midpoint of the IJ vein is 14.81mm with a range of 8 to 27mm. The 65mm introducer needle included in standard central venous access kits is much longer than necessary for IJ vein access. Ultrasound intrinsically does not prevent needle over-insertion. A shorter introducer needle, e.g., 35mm may reduce complications related to excessive needle tip penetration particularly with less experienced operators.