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J Korean Soc Emerg Med > Volume 30(6); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(6): 593-597.
속목정맥 도관 삽입에서 새로운 해부학적 표지자로 쇄골의 유용성
유종훈 , 이상훈
Department of Emergency Medicine, Keimyung University School of Medicine, Daegu, Korea
Utility of the clavicle as a new anatomical target of internal jugular vein catheterization
Jong-Hoon Yoo , Sang-Hun Lee
계명대학교 의과대학 응급의학교실
Correspondence  Sang-Hun Lee ,Tel: 053-258-7895, Fax: 053-258-6305, Email: saorang7@naver.com,
Received: June 24, 2019; Revised: September 16, 2019   Accepted: September 19, 2019.  Published online: December 31, 2019.
ABSTRACT
Objective:
The ipsilateral nipple has been used as a directional guide for the insertion of a conventional central venous catheter via the internal jugular vein (IJV). However, the nipple is not an ideal marker since the position of the nipple varies among the characteristics of patients. The utility of the clavicle was investigated for IJV catheterization instead of the ipsilateral nipple through cadaver dissection.
Method:
A total of 14 cadavers were dissected (six fresh cadavers, eight fixed cadavers). Each cadaver was kept in its supine position, and its head was rotated 30。to the left. Length A was the distance between the jugular notch and the point that the line from the nipple to sternocleidomastoid muscle apex meets the clavicle. Length B was the distance between the jugular notch and the clavicle point that passed the IJV. IJV was cut and its circumference measured at regular intervals.
Results:
Lengths A and B were 3.79±0.35 cm (mean±standard deviation) and 3.71±0.32 cm, respectively, and were significantly correlated (r=0.865, P<0.001). The mean circumference of the vessels were measured to be 3.56±1.29 cm in the right IJV and 3.00±1.32 cm in the left IJV with a significant difference (P=0.013).
Conclusion:
IJV catheterization via the right one, larger than the left one, is appropriate for the first attempt, and we recommend that the needle should be pointed at the clavicle located at a width of two fingers (2nd, 3rd finger average width 1.9 cm) away from the jugular notch.
Key words: Emergency treatment; Catheterization; Central venous; Cadaver; Jugular veins
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