Figure B :- Surface Anatomy Of The Neck Indicating The Procedure For Inserting A CVC Into The IJV Via The Posterior Approach.
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3 Anatomic Consideration In... Satyam Khare, Nivesh Agarwal, Shilpi Jain, Shaleen Agarwal Figure A :- Surface Anatomy Of The Neck Indicating The Procedure For Inserting A CVC Into The IJV Via The Anterior Approach. Figure B :- Surface Anatomy Of The Neck Indicating The Procedure For Inserting A CVC Into The IJV Via The Posterior Approach. (1) (2) (3) (4) (5) (6) (7) (8) (1) Sternal Head of SCM Muscle. (2) Clavicular Head of SCM Muscle. (3) Manubrium. (4) Right Brachiocephalic Vein. (5) Right Subclavian Vein. (6) Right Internal Jugular Vein. (7) Sternal Notch. (8) Clavicle. Sternal Head of SCM muscle. Clavicular Head of SCM muscle. Manubrium. Right Brachiocephalic Vein. Right Subclavian Vein. Right Internal Juglar Vein Sternal Notch Clavicle Fig A-1. The Procedure For Inserting A CVC Into The IJV Via The Anterior Approach. J. Anat. Soc. India 60(1) (2011) Fig B-1. The Procedure For Inserting A CVC Into The IJV Via The Posterior Approach. 28
4 Anatomic Consideration In... Satyam Khare, Shilpi Jain, Nivesh Agarwal, Shaleen Agarwal Graph- 2 COMPARISON OF RESULTS OF M E A S U R E M E N T S O F T H E D I S TA N C E O F IPSILATERAL STERNOCLAVICULAR JOINT TO THE APEX OF SEDILLOT'S TRIANGLE (mm), ON BOTH LEFT AND RIGHT SIDE Radiograph (PA view) showing canula in IJV RESULTS : This study was conducted on a sample of 16 adult cadavers. All the cadavers were male. In the anterior Internal Jugular Venous (IJV) approach there was only one miss on the right side and four misses on the left side (graph-1). In the posterior Internal Jugular Venous (IJV) approach there were two misses on the right side and four misses on the left side(graph-1). The mean distance of apex of Sedillot's triangle on both right & left sides are 42.56mm and 40.94mm respectively(graph-2). DISCUSSION The results confirm that it is much safer and easier to place a central venous catheter into the IJV on the right side with success rate of 93.75% and 87.50% for anterior and posterior approaches on right side respectively, whereas the success rate for anterior and posterior approach of IJV on left side was 75.00% in each case. Hence overall success rate in right side approach of IJV is greater in comparison to left side. Also the success rate through anterior approach on right side was greater as compared to left side with one miss on the right side and four misses on the left side. The result is consistent with the findings of Botha et al. (2006)13 who reported the success of anterior approach of IJV on right and left side as 97.14% & 78.79% respectively. A miss could possibly lead to puncturing the Common Carotid Artery(CCA). especially if the needle passed medial to the IJV. The results suggests that the mean diameter of IJV is slightly more on the right side (16.61 ± 4.26 mm) as compared with the left side (15.92 ± 3.51 mm) with 95% confidence interval for the actual mean to 18.88mm on right side & to 17.78mm on the left side with p value < for both. The distance of apex of Sedillot's triangle from the most superior aspect of sternoclavicular joint of same side is ± 8.47mm on the right side and ± 11.65mm on left side, with 95% confidence interval of actual mean is between and 47.07mm on the right & between and 47.15mm on the left with p value < Besides this the 3 misses (1 ant. & and 2 post.) of right IJV there was no corresponding miss on the left side. Graph-1 :- RESULTS OF SUCCESS(HITS) & FAILURE(MISSES) OF VENOUS PUNCTURE THROUGH VARIOUS APPROACHES HIT Successful insertion of needle in vein MISSES Failure of insertion of needle into vein ARIJV Ant. Right IJV approach PRIJV Post. Right IJV approach ALIJV Ant. Left IJV approach PLIJV Post. Left IJV approach J. Anat. Soc. India 60(1) (2011) 29
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Ankle Block The ankle block is a common peripheral nerve block. It is useful for procedures of the foot and toes, as long as a tourniquet is not required above the ankle. It is a safe and effective technique.