The "medial-oblique" approach to ultrasound-guided central

J. Cardiothorac. Vasc. Anesth. · Dec 2012

Review

The "medial-oblique" approach to ultrasound-guided central venous cannulation--maximize the view, minimize the risk.

Carotid puncture and insertion of a large-bore catheter into the carotid artery is a feared complication associated with internal jugular vein (IJV) cannulation. The use of ultrasound with real-time imaging of the neck vessels during needle insertion has the potential to decrease the incidence of serious complications associated with central venous access. ⋯ The suggested "medial-oblique" approach allows for optimal imaging of the IJV and the carotid artery side by side and following the needle throughout the insertion from skin to vessel penetration in a medial-cephalad to lateral-caudad direction. This technique combines the advantages of the short-axis and long-axis approaches and minimizes the risk of carotid puncture from a medial-to-lateral needle direction.

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- Ralph Dilisio and Alexander J C Mittnacht.
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
- J. Cardiothorac. Vasc. Anesth.. 2012 Dec 1;26(6):982-4.
AbstractCarotid puncture and insertion of a large-bore catheter into the carotid artery is a feared complication associated with internal jugular vein (IJV) cannulation. The use of ultrasound with real-time imaging of the neck vessels during needle insertion has the potential to decrease the incidence of serious complications associated with central venous access. The authors describe a new technique for ultrasound-guided IJV cannulation. The suggested "medial-oblique" approach allows for optimal imaging of the IJV and the carotid artery side by side and following the needle throughout the insertion from skin to vessel penetration in a medial-cephalad to lateral-caudad direction. This technique combines the advantages of the short-axis and long-axis approaches and minimizes the risk of carotid puncture from a medial-to-lateral needle direction.Copyright © 2012 Elsevier Inc. All rights reserved.

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The "medial-oblique" approach to ultrasound-guided central venous cannulation--maximize the view, minimize the risk.

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