Access Basics Internal Jugular Vein IJ Vein Andr

Access Basics Internal Jugular Vein IJ Vein André C. Lapeyre, III, M. D. Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Anatomy Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Anesthesia • Pre-anesthesia re-identify landmarks • 2 D echo identification of artery and vein • 2 D echo identification of direction of puncture • 2 D echo identification of depth of puncture Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Anesthesia • Large skin wheal – skin hurts • Smallest Shortest Needle • tiny moves straight in with gentle aspiration • tiny ¼ to ½ cc of local with each move – avoid venous compression • Keep vein distended • Elevate legs • If appropriate – IV fluids, Valsalva maneuver Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Skin Nick • • At 2 D Echo skin entry site DO NOT go deep !!!!!!! Just large enough for sheath Blunt opening of sub-cutaneous tissue Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Puncture • 2 D Echo direct visualization • Small bore 21 gauge needle • Straight in – bevel directed at patient’s feet • No wiggle • No rotation • No leverage and/or wrist rotation • Gentle aspiration • Needle visualized to enter vein and blood return – remove syringe, prevent air embolus, small pass wire • Small introducer kit Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Puncture • • Wire must pass without any resistance Confirm wire position with fluoro Confirm position by “pressure” Insert 0. 35 wire through small introducer being careful to avoid air embolus when exchanging for sheath wire • Insert sheath Andre Lapeyre, MD © Mayo Clinic

Access and Diagnostic Angiography Jugular Sheath • Removal • • • Andre Lapeyre, MD Aspirate and flush Cover puncture site with Vaseline gauze Gentle pressure during removal Head of bed up 45 degrees after sheath removed Gentle pressure for 5 minutes Check and recheck © Mayo Clinic