Respiratory jugular venodilation: A new landmark for right internal jugular vein puncture in ventilated patients

Objective: To report a new technique for right internal jugular vein puncture using respiratory jugular venodilation as a landmark for vein location. Design: Prospective observational study. Setting: Single community hospital. Participants: Two hundred patients undergoing right internal jugular vein cannulation under general anesthesia. Interventions: Catheter placement was attempted using respiratory jugular venodilation as the primary landmark. When it was not applicable, an alternative technique using the carotid pulse as a landmark was used. Measurements and Main Results: Visibility of the venodilation, the number of needle passes, the success rate, and the incidence of arterial puncture were analyzed. Respiratory jugular venodilation was observed in 158 patients (79%). In this group of patients, the jugular vein was cannulated at the first attempt in 83.5% of patients, and arterial puncture occurred in one patient (0.6%). In the remaining 42 patients (21%) lacking the visible venodilation, catheter placement was accomplished at the first attempt in 42.9% of patients (p < 0.01 v the venodilation-visible group), and 4 patients (9.5%) suffered arterial puncture (p < 0.01), The overall incidence of arterial puncture was 2.5%. The success rate of cannulation (within four needle passes and no arterial puncture) was 98.1% in the venodilation-visible patients and 73.8% in the others (p < 0.01), with the overall success rate of 93%. Conclusions: Respiratory jugular venodilation can he identified in a large proportion of ventilated patients. This experience suggests that respiratory jugular venodilation could be favorably used as the primary landmark for right internal jugular vein puncture in anesthetized patients. Copyright (C) 2000 by W.B. Saunders Company.