Accuracy of Right sternocleidomastoid’s surface landmark for Internal jugular vein catheterization in Thai critically ill patients
Jathurapat Samanpong, MD1, Phitphiboon Deawtrakulchai, MD1,2
Affiliation : 1Division of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Sub-Division of Critical Care Medicine, Division of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Central venous catheterization of the internal jugular vein (IJV) is crucial for critically ill patients. While ultrasound guidance is the recommended method, the surface landmark technique using the sternocleidomastoid (SCM) muscle is still utilized in some settings.
Objective: The present study aimed to assess the accuracy of this technique in Thai critically ill patients and explore related factors.
Materials and Methods: This diagnostic accuracy study enrolled 85 Thai critically ill patients from the medical intensive care units. The primary outcome was the accuracy of the right SCM surface landmark for IJV catheterization in a supine position with the head turned to 45 degrees, measured by the distance between the landmark and the center point of the IJV on 2D ultrasound. Secondary outcomes included the relationship between the IJV and the common carotid artery (CCA) based on the classification model by Lin et al., as well as factors influencing accuracy.
Results: The surface landmark technique achieved an accuracy of 63.53% (54/85). Type b (IJV lateral upward to CCA) was the most frequent, observed in 65.88% (56/85) of cases, while types d and e (small IJV above and lateral to the CCA) were not present in the present study. Height was the only factor significantly associated with accuracy, with shorter individuals exhibiting higher precision rates (p=0.03).
Conclusion: The surface landmark technique for IJV catheterization has limited accuracy in Thai critically ill patients; however, accuracy would increase to 98.82% if moved laterally by 5 mm to the landmark surface. The association between height and accuracy warrants further investigation.
Keywords : Central venous catheterization; Anatomical landmark; Surface landmark; Internal jugular vein
