Nephrology Dialysis Transplantation, Vol 13, Issue 1 134-138, Copyright © 1998 by Oxford University Press
B Lin, C Kong, D Tarng, T Huang and G Tang
Background: Creation of a reliable haemoaccess is a
critical problem for practicing nephrologists once haemodialysis has been
considered. A double-lumen internal jugular-vein catheter is favoured in
most cases requiring temporary haemoaccess. However, numerous
complications, even lethal ones, may occur with the cannulating procedure.
Using ultrasound, we attempted to describe the occult anatomical variations
of vessels which may be responsible for complications.
Methods: A 'SiteRite' ultrasonographic device was
used to inspect the anatomical structure of the internal jugular veins
(IJV) in 104 consecutive uraemic patients undergoing creation of internal
jugular vein temporary angioaccess. Images of the vessels and demographic
data of patients were recorded and analysed. Results:
Anatomical variations of the right and left IJVs were found in 19 (18.3%)
and 17 (16.4%) uraemic patients respectively. Unilateral IJV variations
were discovered in nine patients (8.7%). A total of 27 patients (26.0%) had
IJV anatomical variations that might contribute to difficulty in external
landmark-guided IJV cannulation. Conclusions: The
external anatomical landmarks for cannulating the IJV are not reliable in
about one-quarter of uraemic patients. An ultrasound survey on the IJV
anatomy is recommended for selecting proper puncture site and reducing
risks of insertion complications for IJV dialysis catheters. Key
words: jugular vein; anatomy; uraemia; haemodialysis catheter;
vascular access; ultrasonography
ORIGINAL ARTICLES
Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients
Division of Nephrology, Division of Critical Care, Department of Anesthesiology, Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan; Corresponding author at: PO Box 83-63, Taipei 111, Taiwan
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