Bevel-Down Needle Insertion for Internal Jugular Vein Catheterization Lowers Hematoma Incidence

In anesthetized surgical patients, the incidence of localized hematomas was lower when the puncture needle was inserted with the bevel down than with the bevel up.

Carotid artery puncture and localized hematoma formation often occur when the posterior wall of the internal jugular vein (IJV) is punctured during catheterization. To determine whether inserting the needle with the bevel facing downward reduces the incidence of posterior wall puncture, researchers prospectively randomized 338 patients undergoing thoracic surgery and IJV catheterization to bevel-up (control) or bevel-down needle insertion.

After induction of general anesthesia, patients were placed in the Trendelenburg position with head turned to the left. Experienced anesthesia residents identified landmarks with ultrasound imaging and then inserted a double-lumen catheter into the IJV using the modified Seldinger technique.

The incidence o…

Reviewing Author

Kristi L. Koenig, MD, FACEP

Disclosures

Editorial boardsKoenig & Schultz's Disaster Medicine: Comprehensive Principles and Practices

Kristi L. Koenig, MD, FACEP

Disclosures

Editorial boardsKoenig & Schultz's Disaster Medicine: Comprehensive Principles and Practices