Emergent internal jugular vein cannulation as a risk factor associated with arterial puncture

Introduction

Placement of central venous catheters is frequently associated with serious complications. Arterial puncture is the most common mechanical complication associated with internal jugular vein access procedures (IJVAP). The influence of emergent indication as a sole risk factor for arterial puncture during IJVAP has not been fully explored. We evaluated the impact of emergent IJVAP, performed in the operating room, on the carotid arterial puncture rate.

Methods

We analyzed all landmark techniques of guided IJVAP that were performed by either the anterior or the posterior approach, using the Seldinger technique in the operating theater during a 2-year period. All IJVAP were defined either as elective or emergent. A procedure was defined as emergent if the anesthesiologist judged that any delay would be harmful. The side of the puncture site was chosen according to clinical necessity. The puncture side, number of cannulation attempts, the time relationship between surgical incision and IJVAP, and the number of arterial punctures after cannulation were recorded. Correct placement of the central venous catheter was confirmed by free venous blood return, free flow of fluid through all ports of catheter and postinsertion chest X-ray scan.

Results

We analyzed 86 IJVAP performed in the operating room (22 left-sided and 64 right-sided). In 32 cases, IJVAP were performed as emergent (37.2%). The overall rate of carotid artery puncture was 9.30%. Arterial puncture following emergent IJVAP occurred in seven cases (21.87%). After elective IJVAP, accidental arterial puncture occurred in only one case (1.85%). This difference was statistically significant (P = 0.003). Emergent IJVAP were considerably associated with repeated cannulation attempts (P < 0.001). In 16 cases (50%), emergent IJAVP were performed after surgical incision, including five cases of unintentional carotid puncture. Although the arterial puncture frequently occurred after postincisional emergent IJVAP, the difference was not statistically significant (31.25% vs 12.15%; P = 0.15).

Conclusion

Emergent internal jugular vein cannulation might be identified as a factor associated with an increased arterial puncture rate.