ANATOMIC SUBSTANTIATION OF SELECTION OF THE PLACE OF PUNCTURE AND INTRODUCTION OF THE CENTRAL VENOUS CATHETER IN CARDIOSURGERY PATIENTS
Objective. To carry out an ultrasound evaluation of the features of clinical anatomy and the mutual location of the internal jugular vein and common carotid artery at different levels of the neck scanning to determine the optimal point for puncture and introduction of a central venous catheter in patients undergoing surgical interventions on the heart. There is the ultrasonic assessment of features of clinical anatomy and the relative positioning of the internal jugular vein and common carotid artery in cardiac surgery patients at various levels of a neck scanning for selection of the optimum point for puncture of central veins. Methods. The study included 61 patients who were subjected to ultrasound scanning of the neck vessels from two sides at the following levels: first scanning point - the apex of the triangle formed by the legs of the sternocleidomastoid muscle; the second scanning point is 3-5 cm above the 1st scanning point (approximately at the point of intersection of the external jugular vein with the sternocleidomastoid muscle). The following vessel parameters were recorded: the distance from the skin to the vein wall, the size of the internal jugular vein and its position relative to the common carotid artery. Results. The distance from the skin to the wall of the internal jugular vein, both on the left and on the right, was significantly greater at the 2nd point of scanning, compared to the 1st scan point. The right internal jugular vein was dominant and had a maximum size at the 1st scan point in the largest number of patients. The following regularity is described: in the Trendelenburg position with a slope of 15° and a rotation of the head by 45° at the first point of scanning, only in 33 (54%) and 34 (56%) patients left and right classical (lateral) location of the internal jugular vein was observed; at the second point of scanning - respectively, only in 26 (43%) and 28 (46%) patients. Conclusions. The point of puncture and of the introduction of a central venous catheter located in the region of the apex of the triangle formed by the legs of the right sternocleidomastoid muscle is the most optimal and can be recommended for the internal jugular vein catheterization. Taking into account the considerable variability in the location of the internal jugular vein, the introduction of a central venous catheter is recommended to be performed under ultrasound guidance. What this paper adds The ultrasonic assessment of features of clinical anatomy and the relative positioning of the internal jugular vein and common carotid artery at various levels of neck scanning in cardiac surgery patients was performed. It has been found out that the optimal point for puncturing and catheterization of the internal jugular vein is located in the apex of the triangle formed by the legs of the right sternocleidomastoid muscle.