Yonsei Med J.  2009 Apr;50(2):222-226.

External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

• Karaaslan
• Altinisik
• Peker TT
• Nayir E
• Ozmen S

Abstract

PURPOSE
To investigate the reliability of intra-atrial electrocardiogram (ECG) use for external jugular vein (EJV) catheterization. MATERIALS AND METHODS: Patients undergoing open heart surgery in Suleyman Demirel University Hospital between February and June 2006 were included in the study. Using a sterile Seldinger technique, a triple lumen polyurethane central venous catheter was introduced (Certofix(R) Trio V 720, length 20 cm, 7 French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. RESULTS: In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. CONCLUSION: Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

Keyword

Veins, jugular; catheterization, central venous; monitoring, electrocardiography

MeSH Terms

Catheterization, Central Venous/*methods
Electrocardiography/*methods
Female
Humans
*Jugular Veins
Male
Middle Aged

Figure

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  Fig. 1 Appropriate localization of the external jugular vein catheter on chest X-ray. Catheter tip marked with an arrow.

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  Fig. 2 Fluoroscopic view of the external jugular vein catheter placed in the left innominate vein. Catheter tip marked with an arrow.

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  Fig. 3 Evaluation of the method.

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