외상 환자에서 초음파 유도 내경정맥 도관 삽입 시카테터 바늘과 피부 사이의 적정 각도 = Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV`s anterior-posterior (AP) vessel wall on the longitudinal scan`s midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV`s internal center on screen`s midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5≤ middle CVP ≤10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68±0.30, 1.06±0.31, and 1.23±0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups` mean optimal angles (28.1±6.1, 30.1±4.5, and 28.0±5.0 degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV`s diameter is altered in proportion to the CVP.