- Paper Report
- Open Access
Valve incompetence: a hazard of internal jugular vein cannulation
- Malcolm Watters1
© Current Science Ltd 2000
- Published: 14 September 2000
- Central venous catheter
- colour Doppler
- intracerebral venous blood pressure
Several problems may arise if the internal jugular vein valve is rendered incompetent. Only 90% of humans have such a valve, but there is evidence that puncturing it causes valvular incompetence. The question this study addressed was whether a high approach to internal jugular vein puncture reduced the incidence of internal jugular vein valve damage.
A total of 126 patients scheduled for elective cardiac surgery who had not previously had a central line were recruited
Of these, 24% were later excluded for preexisting internal jugular vein valve incompetence
Patients were randomised to receive either a high approach (1 cm above cricoid cartilage) or a low approach (1 cm below) to internal jugular vein puncture
Colour Doppler ultrasound was then used to assess the blood flow through the internal jugular vein preoperatively, 3-4 days postoperatively before the line was removed, just after removal, and 8 to 27 months later
Incompetence of the jugular vein valve was frequently found postoperatively, 76% with the low approach, 41% with the high approach (statistically significant). This persisted when the catheter was removed (47% low and 28% high). In total, 24 patients still had incompetence at late testing.