1. Alternative technique of fixing IJV catheters
Dr Vamsidhar Chamala, Dr Nitin T Patil, Department of Anaesthesiology, Kasturba Medical College, Manipal
Introduction
Not only it was easy to fix to the skin, but it was also comfortable to inject drugs and IVF during the entire procedure. Since it was lying away from the hairline, it was easy to suture the catheter clamp to the skin and was also easy to apply the tegaderm. Care was taken to not allow the catheter to kink during the entire course of its length.
. However the disadvantages of fixing in this manner include higher chances of infection being close to the hairline, difficulty in adhering of the dressing to the skin because of the hair and difficulty in handling by the healthcare providers It also causes discomfort to the patient. Instead of fixing the catheter in above mentioned manner, we had fixed the IJV catheter by turning away at the skin puncture site and brought the catheter laterally and parallel to the clavicle to fix it in the supraclavicular fossa. Care must be taken to avoid catheter kinking at the skin site by fixing it appropriately. Currently there is no literature available to describe the catheter fixation techniques but there are case reports wherein the right IJV catheters have been tunneled under the skin and placed in the mammary region especially in chronically debilitated patients requiring long term central venous access. .
Central venous catheterization is an important tool in managing patients inside ICU’s and also at other critical care units.
Various indications for central venous catherization include: Difficult peripheral venous access , CVP monitoring, repeated blood sampling, volume loading, insertion of PA catheters, chemotherapy, etc.
However if not properly maintained and taken care of, they are also a potential source of complications including infection, thrombosis, embolism, etc.
Here we present an alternative technique of fixing IJV catheter in the supraclavicular region.
Case
Conclusion
A 55 year old male was electively taken up for CABG in view of triple vessel disease. After confirming NPO, patient was wheeled into OT and baseline monitors with a 5 electrode ECG, NIBP and Pulse Oximetry were attached. A 18G peripheral IV line was secured and patient was positioned for right IJV catherization. Using Seldinger wire method a triple lumen catheter was secured by the anterior approach at the apex of the Sedillot,s triangle. While fixing the catheter it was turned away from the insertion site using catheter clamp and brought the catheter laterally and parallel to the clavicle to fix it in the supraclavicular area.
Fixing the IJV catheter in the supraclavicular region may be advantageous over the conventional method in terms of patient safety regarding catheter hygiene, easy handling and prevention of catheter kinking and infections.
Discussion
Compared to femoral site access, internal jugular or subclavian access has been associated with a lower risk of catheter-related bloodstream infections (CRBSIs) in some studies, Overall, the IJV is better suited, especially in children, although other factors such as interindividual vein size variation need to be kept in mind. After inserting catheter into an IJV, it is conventionally fixed subcutaneously in the lateral aspect of the neck behind the ear lobe to maintain its natural course and also to avoid kinking.
References
1.  Celinski SA, Snafu MG. Central venous catheters. In: Irwin RS, Rippe JM, editors. Irwin and Rippe's intensive care medicine. 6th ed. Philadelphia: Lippincott Williams and Wilkins; pp. 19–37.
2. Morgan GE, Jr, Mikhail MS, Murray MJ. 4th ed. New York: Lange; Clinical Anesthesiology.
3. Arul GS, Livingstone H, Bromley P, Bennett J. Ultrasound-guided percutaneous insertion of 2.7 Fr tunnelled Broviac lines in neonates and small infants. Pediatr Surg Int Aug. 26(8):815-8. .