Left Internal Jugular Vein Cannulation Research Articles

Persistence of the left superior vena cava as an incidental finding in left internal jugular vein cannulation.

Persistence of the left superior vena cava as an incidental finding in left internal jugular vein cannulation.

Fatal bleeding following left internal jugular vein cannulation associated with type A1 endoleak, false aneurysm and aortobronchopulmonary fistula

Fatal bleeding following left internal jugular vein cannulation associated with type A1 endoleak, false aneurysm and aortobronchopulmonary fistula

Ultrasound-guided left internal jugular vein cannulation: Advantages of a lateral oblique axis approach.

Retrospective observational study to evaluate the technique of cannulation guided by ultrasound of the left internal jugular vein (LIJV) using a lateral oblique axis (LOAX) approach with variable angulation in the placement of tunneled central venous catheters (CVC) for hemodialysis. Seventy-one patients with 77 LIJV vascular accesses aged 16 or older who needed CVC for hemodialysis were evaluated. The catheters were inserted, guided by LOAX ultrasound with variable angulation, depending on the angulation of the left brachiocephalic trunk. The success rate, additional instrumentation needs, and number of immediate and late complications were analyzed. Central venous catheters placement was possible in all cases and none of the peelable introducers folded. A placement guide was needed in only eight patients, whose brachiocephalic trunk elongation and angulation was 90°. We found no major complications, and only five cases of minor complications (6.5%): four periprocedural and one displacement of the catheter a week after placement. Tunneled CVC percutaneous cannulation in LIJV guided by ultrasound with the LOAX approach with variable angulation provides very good results, allows visualization of the needle and the vascular structures at the same time, and reduces the number of manoeuvers required for placement and complications that might arise.

Left Internal Jugular Vein Cannulation in a Patient with Thrombosed Right Internal Jugular Vein: A Double Jeopardy?

Left Internal Jugular Vein Cannulation in a Patient with Thrombosed Right Internal Jugular Vein: A Double Jeopardy?

Pseudoaneurysm of Thyrocervical Trunk Following Left Internal Jugular Vein Cannulation.

Pseudoaneurysm of Thyrocervical Trunk Following Left Internal Jugular Vein Cannulation.

Anatomical variations of the left anonymous trunk are associated with central venous catheter dysfunction.

Internal jugular vein cannulation has become increasingly widespread. Compared to the left internal jugular vein (LIJV), the right internal jugular vein (RIJV) is the preferred choice for the placement of central venous catheter (CVC) for hemodialysis, mostly due to the major technical difficulties and higher rate of complications of the LIJV approach. We aimed to investigate whether variability in the direction of the LIJV/brachiocephalic vein (BV) axis on the frontal plane could be a decisive factor in determining CVC dysfunctions. Retrospective cohort study. From our Register, a total of 1489 consecutive patients (age 69 ± 9years, males 60%) in whom a CVC for hemodialysis was placed from January 2012 to June 2014 were selected. LIJV cannulation, compared with RIJV, was associated with a higher rate of catheter dysfunction during an observational period of 2weeks after catheter placement (16 vs.12%; p = 0.005). This complication was strongly correlated with the amplitude of the angle between the LIJV and the ipsilateral BV axis on the frontal plane; an angle ≤ 110° was associated with a higher rate of catheter dysfunction (78 vs.16%; p < 0.001). The anatomical clarification presented in our study provides useful data that could explain the dysfunction rate of CVC inserted in the LIJV. Clinicians who insert high-flow catheters (such as hemodialysis catheters) should be aware of LIJV/BV axis variability and of the possible risks of CVC dysfunction when the angle between the LIJV and ipsilateral BV is ≤ 110°.

Subclavian artery pseudoaneurysm complicating central venous catheterization

Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. The patient underwent urgent endovascular treatment with deployment of covered stent into the left subclavian artery (SCA) after embolization of the origin of the left internal mammary artery with Amplatzer Vascular Plug 4. The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.

An unusual case of a misplaced left internal jugular vein catheter

Introduction: Most often, cannulation of the right internal jugular vein (IJV) is preferred over the left IJV. However, in situations where the right IJV cannot be utilized for accessing the central circulation, as in our case, the left IJV is used. Cannulation of left IJV has additional risks due to the anatomical variations. Despite the use of ultrasound guidance, anatomical variations and tortuous course of the left IJV make cannulation of the left IJV more prone to the failure of cannulation or malposition of the cannula leading to catastrophic complications. Case Report: A 63-year-old female with multiple comorbidities presented with progressive shortness of breath and mild respiratory distress due to bibasilar pneumonia. Despite aggressive management of her pneumonia, she continued to deteriorate and became increasingly hypoxemic, hypotensive with abnormal renal functions necessitating medical intensive care treatment and continuous hemodialysis. As she had a chemo-port in her right subclavian vein, it was determined to avoid insertion of the dialysis catheter in her right IJV. An attempt was made to insert the catheter in her left IJV under ultrasound guidance. The catheter was inserted without any perceived resistance. Blood withdrawn from the ports was however, bright red, and gas analysis revealed arterial blood values. A bed side X-ray revealed that the catheter was in the heart. Conclusion: This is the first reported case where the tip of the cannula was in the left atrium. Despite the use of ultrasound guidance, the anatomical variations and the tortuous course of the left internal jugular vein make its cannulation more prone to failure or malposition of the cannula leading sometimes to catastrophic complications. This case reinforces studies which have shown that even with ultrasound guidance, left internal jugular vein cannulation is fraught with higher risk of complications.

Estimation of the diameter and cross-sectional area of the internal jugular veins in adult patients

IntroductionUnawareness of an asymmetry between the right and left internal jugular vein (IJV) and methodological pitfalls in previous studies raise concerns about such asymmetry. Hence the aim of this prospective non-interventional study was to validate the hypothesis that right IJV diameter is greater than those of left IJV and to determine the cross-sectional area of the IJVs using computed tomography (CT)-scans and original automatic software.MethodsAll consecutive adult outpatients who underwent a thoracic contrast-enhanced (TCE) helical CT-scan during a 5-month period were included. To determine diameter and cross sectional area of the IJVs, we used Advanced Vessel Analysis software integrated in a CT-scan (Advanced Vessel Analysis on Advantage Workstation Windows 4.2; General Electrics) allowing automatic segmentation of vessels and calculation of their diameters and cross-sectional areas.ResultsA total of 360 TCE CT-scans was performed; 170 were excluded from the analysis. On the remaining 190 CT scans, the diameter and cross-sectional area of the right IJV were significantly greater than those of the left IJV (17 ± 5 mm [median: 17 mm, range: 13 to 20 mm] vs. 14 ± 5 mm [median: 13 mm, range: 10 to 16 mm], P < 0.001; and 181 ± 111 mm2 [median: 160 mm2, range: 108 to 235 mm2] vs. 120 ± 81 mm2 [median: 102 mm2, range: 63 to 168 mm2], P < 0.001, respectively).ConclusionsIn a general population of adult outpatients, the diameter and cross-sectional area of the right IJV were significantly greater than those of the left IJV. This could be an additional argument to prefer right over left IJV cannulation.

Cross-sectional area of the right and left internal jugular veins

Objective: To compare the cross-sectional area (CSA) of the right internal jugular vein (RIJV) with the left internal jugular vein (LIJV) using two-dimensional ultrasound and to measure the response to the Valsalva maneuver in both the supine and Trendelenburg positions. Design: Prospective and randomized. Setting: University-affiliated hospital. Participants: Fifty healthy adult volunteers. Interventions: The CSA of both the RIJV and LIJV was measured with a 5-MHz, two-dimensional surface transducer before and during a 10-second Valsalva maneuver with the subjects in the supine position, and then with the subjects in a 10° Trendelenburg tilt. Measurements and Main Results: After the baseline measurements were performed, the subjects were divided into two groups based on the CSA of the RIJV and LIJV. Group 1 had an LIJV CSA equal to or greater than that of the RIJV (n = 10) and group 2 had an LIJV CSA less than that of the RIJV (n = 40). Of the latter 40 patients, 17 (34%) had an LIJV CSA less than 50% of that of the RIJV. In both groups, the CSA of both veins increased significantly with the Valsalva maneuver, Trendelenburg tilt, and both maneuvers combined. Conclusion: The findings suggest that in one third of adults (34%), the LIJV is significantly smaller compared with the RIJV and, combined with operator inexperience, may influence the success rate and risk for complications. Thus, the use of ultrasound and maneuvers that increase CSA is suggested during LIJV cannulation.

Internal jugular vein cannulation: time required under ultrasonographic guidance with a valsalva maneuver.

Time required for the cannulation of right internal jugular vein (IJV) under ultrasonographic guidance with a Valsalva maneuver was investigated in surgical patients. The degree of distension of the IJV and the changes in blood pressure (BP) during the maneuver were also examined. The required time for the cannulation was 11 +/- 5 sec (mean +/- SD, n = 21), and there was no failure in the cannulation. The mean BP decreased significantly during the maneuver, while the vessels enlarged approximately twofold, which facilitated the cannulation. The decrease in BP and the enlargement of the vessels during a Valsalva maneuver were confirmed in the left side, which indicated the feasibility of left IJV cannulation under ultrasonographic guidance.