Right Internal Jugular Vein Research Articles

Dilator-associated complications of central vein catheter insertion: Possible mechanisms of injury and suggestions for prevention

This report discusses different types of dilators used in central line insertion, describes the mechanisms of injury, and proposes guidelines tor safer dilator insertion and improvements in dilator design.* CASE 1 A double-lumen hemodialysls catheter was inserted in an 84-year-old woman with a history of congestive heart failure and renal failure. The anterior approach to the right internal jugular vein (RIJV) at the apex of the triangle formed by the sternocleidomastoid muscle was chosen. The RIJV was entered with the 18-gauge introducer needle and penetrated to a depth of 2 to 3 cm. Dark nonpulsatile blood return was noted. The guidewire was passed smoothly through the needle. A small incision was made around the guidewire with a scalpel. The 12F dilator was passed over the guldewlre to its full extent (about 19 cm) and then withdrawn. The catheter was then inserted over the wire, and blood return was obtained from both ports. Ten minutes after the procedure, the patient complained of respiratory distress and immediately went into cardiac arrest (pulseless electrical actwity). During intubation and resuscitation, a right-side chest tube was inserted, and it drained more than 700 mL of blood A chest radiograph showed that the dialysis catheter was in place in the superior vena cava (SVC), well above the right atrium. It *The authors did not xdentlfy manufacturers by name To their knowledge, all of the currently available central hne kits suffer from dilator design flaws.

Avulsion of the right facial vein during double cannulation of the internal jugular vein

C OMPLICATIONS assocaated with cannulatlon of the right internal jugular vein (RIJV) include carond artery puncture wath hematoma formatton, RIJV thrombosis, pneumothorax, hemothorax, arrhythmlas, brachial plexus and phrenic nerve injury, and catheter breakage. The incidence of these complications has been reported to be less than 10%. a-I2 Patients at risk for major blood loss and hemodynamic compromise frequently have two central venous catheters inserted in close proxamlty to each other In the RIJV. Little has been reported regarding the complications of the double catheter technique. Withington and Carter descrabed insertion of one 8F catheter into another one while attempting a second cannulation of the RIJV3 2 They were unable to pass a pulmonary artery catheter through either 8F catheter. This case report describes avulsion of the right facial vean after the double cannulatlon of the RIJV.

Cannulation of the Right Internal Jugular Vein Is Preferable to That of the Left Internal Jugular Vein

To the Editor.— Cannulation of the right internal jugular vein (RIJV) is advantageous when compared with that of the left internal jugular vein (LIJV) in most circumstances. The RIJV is generally larger than the LIJV 1 and hence an "easier target." Furthermore, the course of the RIJV is almost parallel to the superior vena cava, and, hence, the catheter easily traverses to the superior vena cava. The LIJV joins the subclavian vein at approximately a right angle so that, while attempting placement, a catheter will at times hit the inferior wall at the origin of the left brachiocephalic vein and then either turn into the left subclavian vein, turn retrograde into the LIJV, or not advance into the left brachiocephalic vein. Sheep and Guiney 2 suggest that the circuitous course of the LIJV to the superior vena cava leads to greater contact with the catheter and vessel wall and increases