안전한 속목정맥의 중심정맥도관삽입을 위한 환자의 자세: 중환자를 대상으로 한전향적 관찰 연구

Abstract

Purpose: Carotid artery injuries are common complications during catheterization of the internal jugular vein. To increase successful catheterization, the best position for the reduction of carotid artery injuries was determined. Unlike a previous study, only critically ill patients who needed central venous catheterization in an emergency medical center were included. Three maneuvers were evaluated:Trendelenburg position, head rotation, and adjustments according to ultrasound probe level. Methods: Eight positions were tested in each patient. The positions were classified by maneuver and ultrasound images of each position were stored. Two factors were determined at each position: “safety width” (the part of the internal jugular vein that did not overlap with the carotid artery) and “overlap width” (the part of the internal jugular vein that did overlap with the carotid artery). Results: Compared with the neutral bed position, safety widths were significantly larger in the Trendelenburg position,and there were no statistical difference in overlap widths. Compared with the non-head rotation position, safety widths were smaller and overlap widths were significantly larger in the 45 head rotation positions. Safety widths didnot statistically change safter adjustments for ultrasound probe level. However, changing the ultrasound probe level from the base of Sedillot’s triangle to thyroid cartilage significantly decreased overlap widths. Overall, The group of Trendeleberg position, with non-head rotation, whose ultrasound probe level was thyroid cartilage had largest safety widths among 8 groups. Conclusion: Among the eight positions tested, the Trendelenburg position (with limited head rotation and adjustments for ultrasound probe level) can reduce carotid artery injuries and increase the successful catheterization of the jugular vein in critically ill patients.