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In such scenarios, both needle puncture and passage of guide wire become cumbersome. The incidence of the narrow lumen of internal jugular vein (IJV) is 1% on the right side and 8% on the left side.[2] A novel technique used when the IJV has a small lumen (<0.7 cm) and subclavian puncture is contraindicated is cannulating at the venous confluence of three vessels, i.e., IJV, subclavian vein (SCV), and brachiocephalic vein (BCV) known as the “Pirogoff” confluence.[3] We describe a case where a linear array US probe was used to identify the venous confluence of “Pirogoff” in three simple, quick, and important steps to obtain successful venous cannulation.

indian journal of critical care medicine/indian journal of critical care medicine

Targeting the venous confluence of pirogoff for central venous cannulation insertion, when internal jugular vein cannulation is difficult: A three-step approach