Determination of Anatomic Variations of the Internal Jugular and Femoral Veins Using Ultrasound in the Emergency Department
| Status: | Completed |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | May 2009 |
| End Date: | May 2015 |
| Contact: | Lawrence Land, MD |
| Email: | lland@health.usf.edu |
| Phone: | 813.627.5931 |
Central venous catheterization is a common and important procedure done in the emergency
department. The internal jugular vein (IJV), subclavian vein (SV) and femoral vein (FV) are
commonly used for central venous access. Unfortunately, this procedure has high-risk
complications.
Traditionally, physicians have relied on the use of anatomic landmarks and physical
manipulation such as moving the head or rotating the leg in order to place central
catheters; however, studies have demonstrated that significant anatomic variations exist
within large percentages of study populations. In addition, although studies have
demonstrated that the use of ultrasonography for placement of femoral catheters leads to
lower rates of complications, no previous studies have specifically determined anatomic
variations in the femoral triangle. Therefore, this study will examine the anatomic
variation of the IJV vs. carotid artery and the femoral vein vs. femoral artery in the
emergency room setting. The investigators will study the variation as a function of sex,
age, race, body habitus and degree of head rotation (measured using a goniometer) and in
doing so, the investigators will demonstrate the utility of using ultrasound to place
central lines in order to decrease morbidity.
department. The internal jugular vein (IJV), subclavian vein (SV) and femoral vein (FV) are
commonly used for central venous access. Unfortunately, this procedure has high-risk
complications.
Traditionally, physicians have relied on the use of anatomic landmarks and physical
manipulation such as moving the head or rotating the leg in order to place central
catheters; however, studies have demonstrated that significant anatomic variations exist
within large percentages of study populations. In addition, although studies have
demonstrated that the use of ultrasonography for placement of femoral catheters leads to
lower rates of complications, no previous studies have specifically determined anatomic
variations in the femoral triangle. Therefore, this study will examine the anatomic
variation of the IJV vs. carotid artery and the femoral vein vs. femoral artery in the
emergency room setting. The investigators will study the variation as a function of sex,
age, race, body habitus and degree of head rotation (measured using a goniometer) and in
doing so, the investigators will demonstrate the utility of using ultrasound to place
central lines in order to decrease morbidity.
Inclusion Criteria:
- Patients being cared for in the Tampa General Hospital Emergency Department
- 18 yrs or older
- male or female
- have the anatomy that will be examined (lateral neck and femoral regions)
- speak either English or Spanish
- alert and oriented to person, place, time and situation
- stable vital signs
Exclusion Criteria:
- under 18 yrs
- incarcerated individuals
- those with acute changes in mental status (intoxicated, encephalopathy, psychosis)
- those from whom consent could not be obtained
- those requiring intensive care monitoring
- persons having pathologies that would interfere with the ultrasound investigation
- persons who do not speak English or Spanish
- persons with acute or severe mental or cognitive disabilities
- individuals in a sedated, traumatized or crisis state
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