Anesth Pain Med.  2023 Jan;18(1):84-91. 10.17085/apm.22171.

Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea

Abstract

Background
Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients forwhom it is difficult to establish peripheral IV access. We aimed to investigate the feasibilityand safety of EJV cannulation in surgical patients.Methods: We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collectedclinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included anyEJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis,pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronicmedical records during the hospitalization period for surgery.Results: We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery(49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%).Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases.The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site(65 cases, 0.7%). There was only one case of unplanned intensive care unit admission dueto swelling related to EJV cannulation.Conclusions: Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

Keyword

Anesthesia, general; Catheterization; Infusions, intravenous; Injections; Intraoperative complications; Jugular veins

Figure

  • Fig. 1. External jugular vein (EJV) catheterization. (A) Visualization of the EJV is facilitated. (B) The catheter is inserted over the needle at a shallow angle (approximately 10 degrees) above the EJV after cleaning the insertion site with an alcohol swab. (C) The needle is advanced 1–2 mm farther when blood appears in the flash chamber of the catheter. (D) The catheter is inserted over the needle smoothly while the needle is fixed. (E) The needle is removed. (F) The catheter is connected to fluid line and blood is aspirated via the catheter to confirm the success of catheter insertion.


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