Abstract
BackgroundThe reported overall success rate for central venous catheter (CVC) insertion into the external jugular vein (EJV) is less than other central veins. A contributing factor for this might be the well-documented anatomical variations of the EJV. However, there are no reports correlating these anatomical variations with successful CVC insertion. Our aim was to evaluate the EJV anatomical variations and their clinical relevance.ResultsAll CVCs inserted over the study period were prospectively recorded with emphasis on the times the EJV was accessed, operative difficulties and any anatomical variations with their influence on CVC insertion. Over 15 months, 36 CVCs were inserted, 17 (47%) into EJV. For EJV line insertions, age is 39 days–14 years, 9 into right EJV. Operative difficulty was encountered in 4 patients (24%) where the catheter was inserted into EJV but failed to thread into a satisfactory position. In all 4 patients, further dissection revealed EJV branching into a bigger anterior branch which follows the course of main EJV yet not leading to the right atrium (RA) and a smaller posterior branch leading to RA. Regarding the 4 cases of “the branching EJV”, age is 2–14 years, 3 males:1 female and 3 left:1 right EJV. The overall success rate for CVC insertion through the EJV in this study was 100% including the 4 cases with “the branching EJV”.ConclusionsThis is the first report describing “the branching EJV” and its clinical relevance to CVC insertion.
Highlights
The reported overall success rate for central venous catheter (CVC) insertion into the external jugular vein (EJV) is less than other central veins
In 2013, the author has encountered difficulty inserting a CVC due to an unreported variation in the anatomy of the EJV where it branched into a bigger anterior branch not leading to the superior vena cava (SVC) and a smaller posterior branch leading to the SVC
The choice of the vein to be used for CVC insertion depended on previous sites of cannulation and external visibility of the EJV
Summary
The reported overall success rate for central venous catheter (CVC) insertion into the external jugular vein (EJV) is less than other central veins. There are no reports correlating these anatomical variations with successful CVC insertion. Variations in the formation, course and termination of the EJV have been previously reported in the literature [4], yet there are no reports correlating these variations/anomalies and their clinical relevance in relation to CVC insertions. The anterior branch followed the course of the main EJV unlike the posterior branch which was arising from the EJV at Shalaby Annals of Pediatric Surgery (2020) 16:48 an acute angle above the clavicle. This made threading the catheter into the posterior branch quite challenging
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