Search

To describe a novel endovascular technique for intracaval cement retrieval after spinal surgery. We produced a replica of the intracaval cement fragment and a 3D print to plan the endovascular procedure. A woven caval filter was modified with two drawstring sutures to be used as fishing net. We used a 10F sheath in the right internal jugular vein to place the caval filter proximal to the floating fragment, and a 24F sheath in the right femoral vein was the working access. After the deployment of the caval filter, the following steps were performed through the 24F sheath: (A) The drawstring sutures were snared and retrieved to the skin surface in the groin; (B) the fragment was secured with two snare catheters from the femoral access and one through the lumen of the caval filter; (C) the fragment was broken off with a snared guide wire at the base; (D) the smallest fragment was removed directly with the snare; (E) the larger dislodged fragment was controlled within the periprocedural caval filter by tightening the drawstring and removed through the 24F sheath. Cement fragments located in the inferior vena cava after cement-augmented spinal surgery procedures can be safely removed by the described fishing net technique.

Background Current methods of assessing competence in acquiring point-of-care ultrasound images are inadequate. They rely upon cumbersome rating systems that do not depend on the actual outcome measured and lack evidence of validity. We describe a new method that uses a rigorous statistical model to assess performance of individual trainees based on the actual task, image acquisition. Measurements obtained from the images acquired (the actual desired outcome) are themselves used to validate effective training and competence acquiring ultrasound images. We enrolled a convenience sample of 21 spontaneously breathing adults from a general medicine ward. In random order, two trainees (A and B) and an instructor contemporaneously acquired point-of-care ultrasound images of the inferior vena cava and the right internal jugular vein from the same patients. Blinded diameter measurements from each ultrasound were analyzed quantitatively using a multilevel model. Consistent mean differences between each trainee’s and the instructor’s images were ascribed to systematic acquisition errors, indicative of poor measurement technique and a need for further training. Wider variances were attributed to sporadic errors, indicative of inconsistent application of measurement technique across patients. In addition, the instructor recorded qualitative observations of each trainee’s performance during image acquisition. Results For all four diameters, the means and variances of measurements from trainee A’s images differed significantly from the instructor’s, whereas those from trainee B’s images were comparable. Techniques directly observed by the instructor supported these model-derived findings. For example, mean anteroposterior diameters of the internal jugular vein obtained from trainee A’s images were 3.8 mm (90% CI 2.3–5.4) smaller than from the instructor’s; this model-derived finding matched the instructor’s observation that trainee A compressed the vein during acquisition. Instructor summative assessments agreed with model-derived findings, providing internal validation of the descriptive and quantitative assessments of competence acquiring ultrasound images. Conclusions Clinical measurements obtained from point-of-care ultrasound images acquired contemporaneously by trainees and an instructor can be used to quantitatively assess the image acquisition competence of specific trainees. This method may obviate resource-intensive qualitative rating systems that are based on ultrasound image quality and direct observation, while also helping instructors guide remediation. Electronic supplementary material The online version of this article (10.1186/s13089-019-0119-6) contains supplementary material, which is available to authorized users.

Knowledge of the optimal lengths for central venous catheterization prior to the procedure may lessen the need for repositioning and prevent vascular complications. To establish the optimal lengths for non-tunneled central venous catheter insertion through the right and left internal jugular veins. We included 92 children who received US-guided central venous catheterization via right or left internal jugular veins in intensive care units. The calculated distance between the skin and carina was considered the optimal length for right and left internal jugular venous catheterization. Univariate and multivariate linear regression analyses was used to identify predictors. Age, height and weight showed significant correlations with optimal insertion lengths for right and left internal jugular vein approaches on univariate analysis, while height was the only significant independent predictor of optimal insertion length. The optimal insertion lengths (cm) suggested by our data are, for the right internal jugular vein 0.034 × height (cm) + 3.173, and for the left 0.072 × height (cm) + 2.113.

The objective of this study is to determine the best way to access and the position in which the patients must remain in order to obtain the best transversal section of the right internal jugular vein (RIJV) section during the catheterization by ultrasound, allowing a safer and precise access. The three possible ways to access the RIJV, anterior, lateral and posterior, from 57 healthy children, were examined by ultrasound in one similar sequence of positions: horizontal dorsal decubitus with the head centered in neutral position with and without the use of a pillow; horizontal dorsal decubitus with contralateral rotation of the head with and without the use of a pillow; horizontal dorsal decubitus with the head centered in neutral position and the patient in the Trendelenburg position without the use of a pillow. The relation between the different positions and punction regions in RIJV were established using analysis of variance. As a result, the lateral punction with the patient in the Trendelemburg position offered a largest area of the RIJV transversal section in comparison to all the other options (P < 0.0001). In conclusion, this study demonstrated that the safer and precise way for the RIJV catheterization in pediatric patients is obtained in Trendelenburg position with lateral access and without a pillow.

Evaluation of suitability and safety of venous port implantation with catheter insertion via the right internal jugular vein in oncology patients.One hundred one totally implantable venous ports were placed in 100 patients with malignancies from January 1, 2003 until March 31, 2005. Catheter of venous port was preferably inserted via the right internal jugular vein. We recorded a number of successful implantations using this venous approach and the rate of complications during the procedure and follow-up.Ninety-seven catheters (96%) of totally implantable venous ports were inserted via the right internal jugular vein in 96 patients, and only in four cases were we not able to access this vein. We had no complications related to catheter insertion via the right internal jugular vein. Follow-up was made in all 96 patients with a total access days of 41 in 151 days (mean: 407 days). Premature catheter removal was required in six (6.2%, 0.144 per 1,000 access days) due to complications: three catheter dislocations/malfunctions (3.1%, 0.072 per 1,000 access days), one port-related sepsis, one pocket port infection, and one decubitus over port (1%, 0.024 per 1,000 access days). Six venous ports were removed after completion of the treatment at the patient's request.The placement of totally implantable venous ports with catheter insertion via the right internal jugular vein has a high success rate without any early complications. Follow-up also demonstrates a low incidence of late complications requiring port removal.

Retrievable inferior vena cava (IVC) filters are placed in patients who are at temporary increased risk for pulmonary embolism, with or without contraindication for anticoagulation, with the expectation of subsequent removal. The failure to retrieve nonpermanent IVC filters is an increasingly encountered dilemma for vascular interventionalists. One of the more common causes of technical failure of retrieval is the presence of tilt in the orientation of the IVC filter, which may result in the retrieval hook abutting the wall of the IVC, preventing contact with the removal system [1]. This issue may be compounded by endothelialization of the filter hook [2]. We describe a nonconventional method for the retrieval of tilted IVC filters in two patients. This method uses a femoral access site that is contralateral to the direction of filter tilt in addition to the right internal jugular vein (IJV) access site. A cone-over-guide wire is then used to retrieve the filter, which has been realigned to the caval axis by the gentle application of tension on the guide wire ends. This technique can be used for filters of both the half-basket and double-basket design, when conventional and other nonconventional techniques fail and may make retrieval difficulties pertaining to filter hook endotheliazliation less relevant.

The placement of an internal jugular vein (IJV) catheter is considered to be more difficult in morbidly obese patients. The objective of this study was to compare the success of simulated IJV puncture between morbidly obese patients and a nonobese control group.Thirty-four morbidly obese patients with body mass index (BMI, kg/m(2))/=40 were compared with 36 patients with BMI30. Right IJV puncture was simulated using an ultrasound probe directed towards the sternal notch at the midpoint between the sternal notch and the mastoid process. The investigator placing the probe was blinded as to the image being created on the ultrasound machine. Success rate was assessed at three different head rotation angles from midline; 0 degrees , 30 degrees , and 60 degrees .There was no statistically significant difference in successful simulated IJV puncture between two groups for any of the head positions. However, there was a higher incidence of the carotid artery (CA) puncture in the morbidly obese patient group when the head rotation was advanced from neutral position to 60 degrees (p0.05). In addition, the ultrasound showed significantly more overlapping of the IJV over the CA in morbidly obese patients at 0 degrees (p0.05) and 30 degrees (p0.05). Our results show no statistically significant difference in success rate of IJV puncture between morbidly obese patients and nonobese patients. Keeping the head in a neutral position in morbidly obese patients minimizes the overlapping of the IJV over the CA and the risk of CA puncture.However, due to the fact that even in the neutral position there is a significant increase in overlap between IJV and CA, we recommend the use of ultrasound guidance for IJV cannulation in obese patients.

Introduction In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA). This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery and can be a life-saving procedure. Case presentation In the first case, an anesthetist attempted ultrasound-guided access to the right internal jugular vein during the preoperative preparation of a 66-year-old Caucasian man. A 7-French (Fr) triple-lumen catheter was inadvertently placed into his arterial system. In the second case, an emergency physician inadvertently placed a 7-Fr catheter into the subclavian artery of a 77-year-old Caucasian woman whilst attempting access to her right internal jugular vein. Both arterial punctures were successfully closed by means of a percutaneous closure device (Angio-Seal). No complications were observed. Conclusions Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This report demonstrates two practical points that may help clinicians in decision-making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.

Percutaneous access of the right internal jugular vein for coronary sinus cannulation in pediatric patients undergoing electrophysiologic studies may be technically difficult. We report the use of an ultrasound-guided technique for obtaining jugular venous access. Forty-five pediatric patients who underwent electrophysiologic study were analyzed. Access was obtained in 100 % of the patients using this technique with no major complications. Ultrasound guidance for access of the internal jugular vein for coronary sinus cannulation during electrophysiologic studies in pediatric patients, may increase the success rate and prevent the development of complications.

Conscious male rhesus monkeys were given epinephrine bitartrate (1 μg/kg.min) through a catheter implanted in the right internal jugular vein. Blood samples were taken from the portal vein through another catheter before, during, and after a 15-minute-long jugular infusion. Sugar in the plasma rose during, and was still high 10 min after the infusion, while mean immunoreactive insulin decreased during the infusion and rose dramatically after its termination. Ergotamine tartrate (14 μg/kg.min) while not preventing a rise in plasma sugar concentration, inhibited the expected insulin decrease during epinephrine infusion.