External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

Central venous access plays an increasingly important role in the delivery of modern care.Many studies on the venous access sites for central venous catheterization have been conducted.[1][2][3][4][5] The preferred access site for central venous catheter placement continues to be the right internal jugular vein (IJV).When the right IJV is not available for central venous access, the second access site remains variable.Although the left IJV and the subclavian veins (SCV) have been used for second access, several studies suggest that both SCVs and the left IJV should be avoided because of a high incidence of procedural complications (pneumothorax, arterial puncture) as well as central venous stenosis and thrombosis.[2][3][4][5][6] The left IJV is also related with a high incidence of catheter malfunction.6 Some authors believe that the second venous access after the right IJV should be the right external jugular vein (EJV).3,7 One reason for use of the right EJV is its relatively straightforward course and short length, which are very similar to those of right IJV.A second reason is that the EJV is easily accessed, given its superficial location on the neck.7 However, it is suggested that the incidence of malpositioned catheters via the EJV approach makes this route unreliable.8 To decrease the incidence of catheter dislodgement, vessel wall erosion, thromboembolism and catheter malfunction, accurate positioning of the catheter tip near or at the junction of the superior vena cava (SVC) and right atrium (RA) is necessary.9 It is possible to decrease the incidence of malposition with the use of additional techniques.Various techniques have been determined to ensure the correct placement of central venous catheters.An alternative