Nötral baş pozisyonunda karotis arter palpasyonu yardımıyla internal jugular ven kanülasyonunun başarı oranı

Amaç: İnternal jugular ven (İJV) kanülasyonu bazı klinik durumlarda baş nötral pozisyonda tutularak yapılmalıdır. Ancak bu pozisyonda hangi anatomik işaretleme noktasının kullanılması gerektiği açık değildir. Bu çalışmanın amacı baş nötral pozisyonda iken karotis arter (KA) palpasyonu kullanılarak yapılan sağ İJV kanülasyonunun başarı oranlarını araştırmaktır. Gereç ve yöntem: Bu prospektif randomize çalışma iki aşamada dizayn edildi. Birinci aşama: Birbirini takip eden 30 servikal bilgisayarlı tomografi görüntüsü çalışma öncesi sağ İJV ve KA arasındaki ilişkiyi belirlemek için incelendi. İkinci aşama: Sağ İJV kanülasyonu yapılması planlanan toplam 150 hasta çalışmaya alındı. Hastaların başı nötral pozisyonda tutuldu. Genel anestezi altında trendelenburg pozisyonu ve soluk sonu pozitif basınç uygulandı. Sağ İJV kanülasyonu 10 farklı klinisyen tarafından KA palpasyonu işaret noktası alınarak, iğneye medial yada laterale açı verilmeksizin uygulandı. Öncelikli hedefimiz iğne ile ilk üç girişimde sağ İJV ulaşabilme başarı oranlarının belirlenmesi idi. Bulgular: İğnenin toplam üç girişimde sağ İJV'ye ulaşma oranı %96,7 idi. Klinisyenler arasında başarı oranları açısından istatistiksel fark yoktu. Hastaların hiçbirinde KA delinmedi. Sonuç: Başın nötral pozisyonda tutulduğu hastalarda sağ İJV kanülasyonu için yüksek başarı oranlarından dolayı KA işaret noktası olarak etkili bir şekilde kullanılabilir.

The success rate of carotid artery palpation guided internal jugular venous cannulation in patients with a neutral head position

Objectives: Internal jugulary venous cannulation (IJV) should be performed in patients while maintaining a neutral head position for a variety of clinical conditions. However, in this position, the landmark that should be used is unclear. Our aim was to evaluate the success rate of right IJV cannulation guided by carotid artery (CA) palpation in a patient with a neutral head position. Materials and methods: The prospective randomized study was designed as two parts. Part 1: Prior to this study we conducted a priliminary evalu- ation with CT scans of 30 consecutive patients to determine the relationship with right IJV and the CA. Part 2: A total of 150 patients who planned right IJV cannulation were included in the study. Each patient's head was placed in the neutral position. Under general anesthesia, the patient was positioned in the Trendelenburg position and ventilation was provided with a positive end-expiratory pres- sure. Right IJV cannulation was performed by ten different clinicians using CA palpation to guide the needle, which was not angled eighter medially or laterally. The primary outcome variable was the cumulative success rate, which was defined as right IJV puncture achieved in the first 3 attempts using a needle. Results: The cumulative success rates on the first 3 attempts were 96.7%. No differences were observed between the clinicians. CA puncture did not occur in any patient. Conclusion: CA guided right IJV cannulation can be used effectively due to its high success rate in patients whose heads are maintained in a neutral position.

Kaynakça

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