Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients – a prospective observational pilot study.

Authors

  • Gentle Sunder Shrestha Intensivist and Anaesthesiologist, Department of Anaesthesiology, Institute Of Medicine, Tribhuvan University Teaching Hospital, Kathmandu
  • Sabin Koirala Anaesthesiologist, Department of Anaesthesiology and Critical Care, Grande International Hospital, Kathmandu
  • Arjun Gurung Anaesthesiologist, Department of Anaesthesiology, Institute Of Medicine, Tribhuvan University Teaching Hospital, Kathmandu
  • Prakash Chand Medical Officer, Department of Critical Care Medicine, Alka Hospital Pvt Ltd, Jawalakhel, Lalitpur

DOI:

https://doi.org/10.3329/bccj.v5i2.34384

Keywords:

Central Venous Cannula (CVC), Coagulopathic Patient, Internal Jugular Vein, Point of Care Ultrasound (POCUS), Venous Cannulation

Abstract

Aim: This study aims to evaluate the safety of ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients.

Methods: Adult subjects admitted in the intensive care unit, undergoing emergency cannulation of internal jugular vein under real time ultrasonographic guidance with platelet count less than 50,000/cu mm and/or international normalized ratio (INR) more than 1.5 were enrolled. Major and minor complications during the procedure were noted.

Results: Internal jugular vein was successfully cannulated in all the patients. The mean INR of patients having minor complications (provided that platelet count > 50000) was found to be 3.07 with 95% confidence interval(CI) being 2.37-3.77. The mean platelet count of patients having minor complications (provided that the INR<1.5) was found to be 27428 with 95% CI being 19428-36000. There was a significant relationship between margin of safety and occurrence of minor complications (>7mm vs 7mm or less; p value 0.027). Number of attempts while performing internal jugular vein cannulation was associated with minor complications (mean 1.5 with CI 1.2-1.78 vs mean 1.08 with 95% CI 1.00-1.25; p value 0.023). No major complications were reported during the study regardless of platelet count, INR, margin of safety or number of attempts.

Conclusions: Emergency cannulation of internal jugular vein may be safely performed in coagulopathic adult patients under real-time ultrasound guidance when performed by an experienced physician.

Bangladesh Crit Care J September 2017; 5(2): 93-96

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Published

2017-10-22

How to Cite

Shrestha, G. S., Koirala, S., Gurung, A., & Chand, P. (2017). Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients – a prospective observational pilot study. Bangladesh Critical Care Journal, 5(2), 93–96. https://doi.org/10.3329/bccj.v5i2.34384

Issue

Vol. 5 No. 2 (2017)

Section

Original Articles

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