Endomyocardial biopsy: indications and procedures
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The right internal jugular vein is the most common site for performance of right ventricular endomyocardial biopsy procedures.[11] With the patient’s head turned to the left 30° to 45°, the internal jugular vein is located lateral to the carotid artery within the anterior triangle of the neck formed by the sternal and clavicular heads of the sterno-cleidomastoid muscle and the clavicle (Figure 13.2). This triangle may be clearly outlined by having the patient raise his or her head off the table briefly to tense the muscular boundaries. Entry into the jugular vein in the upper third of this triangle, well above the clavicle, will lessen the risk of pneumothorax and allow for easier compression of accidental carotid punctures, as well as the venous access site after the procedure. Routine use of ultrasonography is encouraged to identify the location and size of the jugular vein prior to access attempt, particularly in patients with challenging surface anatomy (Figure 13.3). The jugular vein is most commonly located lateral to the carotid artery, is easily compressible when pressure is applied to the ultra-sound transducer, and lacks the pulsatility of the artery, which may be confirmed by color or pulse wave Doppler.[13] Use of sonography during venous access has been shown to improve access time and decrease complication rates.[14]
Cardiorespiratory system
Helen Butler, Neel Sharma, Tiago Villanueva in Student Success in Anatomy - SBAs and EMQs, 2022
13 A 50- year- old woman has recently returned from Ghana and presents to A&E with a 2- day history of rigors. A blood film demonstrates Plasmodium falciparum with a parasite count of 3%. On examination she is drowsy with a Glasgow Coma Scale score of 6/15, tachycardiac at 134 beats per minute and hypotensive at 60/55 mmHg. The medical registrar requests that a central line is inserted for aggressive fluid resuscitation. Which of the following statements regarding line insertion is NOT correct? The internal jugular vein is commonly used for central line placement and is used to monitor right atrial pressure.It can be used for parenteral feeding and the administration of drugs.The femoral vein is used preferentially because it has a lower risk of infection.The femoral vein lies medial to both the femoral artery and nerve.Complications of catheterising the subclavian vein include iatrogenic pneumothorax.
Haemodynamics: flow, pressure and resistance
Neil Herring, David J. Paterson in Levick's Introduction to Cardiovascular Physiology, 2018
CVP can be monitored directly in intensive care units by a catheter inserted into the internal jugular vein. However, during routine clinical examination CVP is assessed indirectly by inspection of the neck veins (Figure 8.23). The external jugular vein runs over the sternocleidomastoid muscle and the internal jugular vein runs deep to the muscle. When a human is semi-supine, the lower part of the jugular vein is normally distended but the upper part is collapsed because blood in the upper part is at subatmospheric pressure, because of gravity (Figure 8.2). From the sigmoidal pressure-volume curve of veins, we know that at the point of venous collapse, the transmural pressure is approximately zero. Therefore, the CVP must equal the pressure exerted by the vertical column of blood between the point of jugular vein collapse and the right atrium.
Propofol/dexmedetomidine Versus Desflaurane Effects on Post Hepatectomy Hepatocellular Injury
Published in Egyptian Journal of Anaesthesia, 2023
Ola A. Saad Ali Lashin, Mohamed M. Abd- Elfattah Ghoneim, Hany M. Mohamed Elzahaby, Mohamed M. Mohamed Awad Rashed, Sahar M. Talaat Taha
After tracheal intubation, all patients of both groups were ventilated at 6–8 ml/kg tidal volume to keep end-tidal CO2 levels around 35 mmHg. A central venous line was placed in the internal jugular vein, and an invasive arterial line was placed in the radial artery. Patients were monitored for invasive blood pressure, blood oxygen saturation, ECG, end-tidal CO2, arterial blood gases, and urine output. In group A, anesthesia was maintained by infusing propofol at a rate of 0.1–0.2 mg/kg/min and dexmedetomidine infusion of maintenance dose at a rate of 0.6 mcg/kg/h. Ventilation was maintained by an oxygen-air gas mixture to achieve FiO2 0.5 and a flow of 2 L/min in a closed respiratory system. In group B, anesthesia was maintained by desflurane inhalation with vaporizer set between 4 and 10 vol% in FiO2 0.5 and a flow of 2 L/min in a closed respiratory system. Fentanyl was infused into both groups at a rate of 1–2 mcg/kg/h, and atracurium was infused at a rate of 0.3–0.6 mg/kg/h.
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.
Distension of the maxillary vein with hepatojugular reflux
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Kelly T. Le, Bruce F. Sabath
Bedside estimation of central venous pressure (CVP) was described in 1930 by Sir Thomas Lewis who observed that the top of the jugular veins was similar to the top of the fluid column in a CVP manometer. While the internal jugular vein is preferred because it lacks valves and is more in line with the right atrium, the external jugular vein can be used, particularly in cases of extremely elevated venous pressure because the top of the internal jugular vein courses intracranially and cannot be visualized. The hepatojugular reflux maneuver is performed by applying pressure of 20–30 mmHg at the mid-abdomen for 10–30 seconds. If CVP rises >4 cm throughout the maneuver, this correlates with elevated right atrial pressure. In patients with significant volume overload, distant tributaries of the external jugular vein can become distended as well (video).
Related Knowledge Centers
- Carotid Sheath
- Common Carotid Artery
- Jugular Foramen
- Skull
- Neck
- Brain
- Jugular Vein
- Vagus Nerve
- Face
- Retromandibular Vein