Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 $cmH_2O$, $5{\leq}$ middle CVP ${\leq}10\;cmH_2O$, and high CVP>10 $cmH_2O$) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups($0.68{\pm}0.30$, $1.06{\pm}0.31$, and $1.23{\pm}0.49$ cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles ($28.1{\pm}6.1$, $30.1{\pm}4.5$, and $28.0{\pm}5.0$ degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.

외상 환자에서 초음파 유도 내경정맥 도관 삽입 시 카테터 바늘과 피부 사이의 적정 각도