Venous and Arterial Access, EP Catheters, Positioning of Catheters
Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski in Handbook of Cardiac Electrophysiology, 2020
The internal jugular vein is located anterior and lateral to the carotid artery. It lies behind the clavicular head of the sternocleidomastoid muscle. The site of puncture is approximately at the level of the apex formed by both heads of the sterno-cleidomastoid muscle and medial to the lateral border of the clavicular head. The Trendelenberg position is helpful in distending the vein. The syringe and needle are directed lateral to the carotid artery. When a free flow of venous blood is encountered, the syringe is detached, the needle held firmly, and a guide-wire advanced. At all times the guide-wire should be advanced without any perceived resistance. The needle is then removed and an intravascular sheath advanced as described previously. The potential complications of internal jugular vein access include carotid artery puncture with resultant hematoma, potential air embolism, and pneumothorax. Digital pressure should be maintained for 5–10 min in the event of inadvertent carotid artery puncture. Air embolism can be prevented by keeping the patient in the Trendelenberg position until the sheath is advanced. The risk of pneumothorax can be minimized by obtaining access in the neck at a higher level.
Pediatric Orthopedic Trauma: Spine and pelvis trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Atlantoaxial rotatory displacement (AARD) is a term that refers to a subluxation of the atlantoaxial articulation. The subluxation can be the result of trauma or more commonly infection such as upper respiratory tract infection (Grisel syndrome) or retropharyngeal abscesses. Inflammation from tonsillectomy or pharyngoplasty may also result in subluxation. Patients often present with symptoms of neck pain, headache, and rotation of the head due to strong spasm of the sternocleidomastoid muscle (Figure 20.2.11). Asymmetry of the lateral masses can be appreciated on open mouth odontoid x-rays, and coronal and axial CT images and are classified based on the amount of angulation and displacement. Treatment depends on the underlying cause of the AARD and duration of symptoms. Acute cases can often be successfully treated with a cervical collar, while long standing cases may require surgery [18–20].
Surgical Management of Parathyroid Disorders
Madan Laxman Kapre in Thyroid Surgery, 2020
For primary hyperparathyroidism caused by single adenoma, resection of the involved gland is considered adequate surgery. Intra-operative PTH monitoring criteria (mentioned in detail below) guide the surgeon toward successful removal of the gland in question. For multiglandular hyperplasia and syndromic HPT, the choice remains between three to three and a half gland resection, that is subtotal parathyroidectomy versus total parathyroidectomy with auto-graft. Since subsequent neck surgery for medullary carcinoma thyroid is suspected in MEN 2 syndromes, the remnant parathyroid should preferably be transplanted in the forearm muscle brachioradialis. For other scenarios, the sternocleidomastoid muscle is a suitable alternative. The auto-graft should be marked with titanium clips or non-absorbable sutures for ease of identification in case of re-operative parathyroid or thyroid surgery.
Pre-anaesthetic ultrasonographic assessment of neck vessels as predictors of spinal anaesthesia induced hypotension in the elderly: A prospective observational study
Published in Egyptian Journal of Anaesthesia, 2022
Bassant M. Abdelhamid, Abeer Ahmed, Mai Ramzy, Ashraf Rady, Haitham Hassan
Ultrasonographic examination of the right IJV was conducted with the patient supine while the neck rotated to the left (at only an approximate 40° to avoid venous occlusion at the opposite side). A linear probe with a 7–12 MHz frequency and a depth of 3 cm (Siemens ACUSON X300 Ultrasound Systems) was gently placed over the neck. The sternocleidomastoid muscle was used as an external landmark. The right IJV was identified just below the bifurcation of the sternal and clavicular heads of the muscle. The right JIV was examined over three full respiratory cycles using the M- mode in the transverse axis. The maximum IJV-D and IJV-A were recorded during each cycle, and the averages were computed. Then, using a protractor set on the operating table, the patient was placed at a 10° Trendelenburg position, and the same ultrasonographic measurements were repeated [18]. (Figure 1).
Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes
Published in Physiotherapy Theory and Practice, 2019
Suzana C Almeida, Steven Z George, Raquel D. V Leite, Anamaria S Oliveira, Thais C Chaves
The points evaluated by algometry were the thenar region of the nondominant hand and the nine sites described by the American College of Rheumatology (Wolfe et al., 1990), including the following: 1) sternal border of the sternocleidomastoid muscle above the head of the clavicle; 2) midpoint of the upper trapezius muscle; 3) second rib, lateral to the costochondral junction, on the upper surface (request contraction of the pectoralis major); 4) 2–4 cm distal to the lateral epicondyle (m. brachioradialis); 5) medial knee fat, proximal to the joint interline; 6) insertion of the suboccipital muscle; 7) supraspinatus insertion above the spine of the scapula, near the upper edge; 8) superolateral quadrant of the buttock, anterior to the muscle (contraction of the gluteus maximus); and 9) posterior to the greater trochanter.
Vertebral artery injury caused by glass remnants in the neck: A case report
Published in Acta Oto-Laryngologica Case Reports, 2019
Keisuke Mizuno, Shogo Shinohara, Yoshihiro Omura, Hirotoshi Imamura, Masashi Shigeyasu, Tetsuhiko Michida, Kiyomi Hamaguchi, Shinji Takebayashi, Keizo Fujiwara, Yasushi Naito
Five days after embolization, we performed the neck surgery. We opened the wound and detected numerous granulomatous tissues around the right carotid sheath. We incised the right sternocleidomastoid muscle to obtain a better operating field. The carotid and jugular systems were explored, and the repaired internal jugular vein was detected. No damage was found to the carotid artery or vagal nerve. We dissected the granulomatous tissue on the lateral side of the carotid sheath by pulling the carotid sheath medially. A hematoma was detected on the right of the C4-5 vertebral body, and the right sympathetic trunk was apparently transected. We found the larger glass piece piercing between the C4 and C5 transverse processes (Figure 3A) and carefully pulled it off without any bleeding. The smaller piece was detected on the lateral side of the larger piece and was removed without damaging the adjacent organs (Figure 3B). There was no bleeding after the operation, and the patient enjoyed his daily meal without dysphagia, although the right vocal cord paralysis was not recovered within the observation period. The patient was discharged on postoperative day 5.
Related Knowledge Centers
- Accessory Nerve
- Nuchal Lines
- Skull
- Temporal Bone
- Sternum
- Aponeurosis
- Clavicle
- Anatomical Terms of Muscle
- Mastoid Part of The Temporal Bone
- Muscle Fascicle