A New Biplane Ultrasound Probe for Real-Time Visualization and Cannulation of the Internal Jugular Vein

Ultrasound guidance is recommended for cannulation of the internal jugular vein. Use of ultrasound allows you to identify relevant anatomy and possible anatomical anomalies. The most common approach is performed while visualizing the vein transversely and inserting the needle out of plane to the probe. With this approach needle tip visualization may be difficult. We report the use of a new biplane ultrasound probe which allows the user to simultaneously view the internal jugular vein in transverse and longitudinal views in real time. Use of this probe enhances needle visualization during venous cannulation. 1. Introduction Ultrasound (US) guidance is recommended for cannulation of the internal jugular vein (IJ) [1–3]. A recent meta-analysis found that US guided central venous access may lead to decreased risks of hematoma, arterial puncture, or pneumothorax [4]. Use of US in real time allows you to identify the relevant anatomy and any possible anatomical anomalies and visualize the path of your needle. US guided central venous access is primarily performed while visualizing the vein transversely and inserting the needle out of plane to the US probe. One major limitation of this approach is that visualization of the needle tip can be difficult. Failure to visualize your needle tip can lead to inadvertent arterial puncture or pneumothorax. We report the use of a new dual plane 4–10 megahertz US probe (BK 8824, BK Medical USA; Peabody, MA) which allows the user to simultaneously view the carotid artery (CA) and IJ in transverse and longitudinal views in real time (Figure 1). This provides the user with the familiar transverse view while being able to more clearly visualize your needle in the longitudinal view. Figure 1: A pictorial depiction of the BK 8824 US probe showing the configuration of the transverse and longitudinal transducers. T: transverse transducers; L: longitudinal transducer. 2. Case Presentation After positive initial experiences using this probe with a phantom (Blue Phantom, CAE Healthcare Sarasota, FL; Figure 2), we were able to cannulate the right IJ in a patient requiring central venous cannulation for surgery. Figure 2: Images from our use in a Blue Phantom training phantom with an 18 gauge 40 millimeter VascularSono cannula (Pajunk USA, Norcross, GA). This is the ideal view that can be obtained with this probe. You can clearly see the needle entering the simulated vein in both views, and the tip is clearly in the lumen in the longitudinal view. V: simulated vein. A 60-year-old, 78？kg, female with a past medical history significant