Options for difficult central venous cannulation insertion?

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A commonly encountered difficulty during US-guided cannulation is the small lumen of the vessel (especially internal jugular vein) in patients who are volume deficient or have a history of multiple cannulations” Dhiman et al (2018).

Extract:

“A commonly encountered difficulty during US-guided cannulation is the small lumen of the vessel (especially internal jugular vein) in patients who are volume deficient or have a history of multiple cannulations.

In such scenarios, both needle puncture and passage of guide wire become cumbersome. The incidence of the narrow lumen of internal jugular vein (IJV) is 1% on the right side and 8% on the left side.[2] A novel technique used when the IJV has a small lumen (<0.7 cm) and subclavian puncture is contraindicated is cannulating at the venous confluence of three vessels, i.e., IJV, subclavian vein (SCV), and brachiocephalic vein (BCV) known as the “Pirogoff” confluence.[3] We describe a case where a linear array US probe was used to identify the venous confluence of “Pirogoff” in three simple, quick, and important steps to obtain successful venous cannulation.” Dhiman et al (2018).

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Reference:

Dhiman, D., Saini, V., Sethi, S. and Samra, T. (2018) Targeting the Venous Confluence of Pirogoff for Central Venous Cannulation Insertion, When Internal Jugular Vein Cannulation is Difficult: A Three-Step Approach. Indian Journal of Critical Care Medicine. 22(10), p.760-761.

doi: 10.4103/ijccm.IJCCM_331_18.

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