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속목정맥 도관 삽입에서 새로운 해부학적 표지자로 쇄골의 유용성

Utility of the clavicle as a new anatomical target of internal jugular vein catheterization

대한응급의학회지 2019년 30권 6호 p.593 ~ 597
유종훈 ( Yoo Jong-Hoon ) - 계명대학교 의과대학 응급의학교실

이상훈 ( Lee Sang-Hun ) - 계명대학교 의과대학 응급의학교실

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.

키워드

Emergency treatment; Catheterization; Central venous; Cadaver; Jugular veins
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