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[Valve injury: a new complication of internal jugular vein cannulation]
M Imai1, Y Hanaoka, F Murakami
1Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Insights
Physicians often miss the internal jugular venous valve, crucial for preventing brain backflow. This study details its anatomy and function, offering insights into safe cannulation techniques to avoid injury.
Area of Science:
- Anatomy
- Physiology
Context:
- Internal jugular vein cannulation is a common medical procedure.
- The internal jugular venous valve's existence and function are often overlooked by physicians.
Purpose:
- To describe the anatomic appearance and assess the competence of human internal jugular valves.
- To identify a safe approach for percutaneous internal jugular vein cannulation, avoiding valve injury.
Summary:
- The study examined 19 internal jugular valves from cadavers and used endoscopic and ultrasound techniques in living subjects.
- Internal jugular valves, located 0.5-2.0 cm above the vein's termination, were visualized and their competence assessed via pressure gradients (50-100 mmHg).
Impact:
- Highlights the anatomical and functional significance of the internal jugular venous valve.
- Identifies a risk of injuring the internal jugular venous valve during central approach cannulation.
- Provides crucial information for refining internal jugular vein cannulation techniques to enhance patient safety.
Abstract:
Although internal jugular vein cannulation is performed commonly, most physicians are not aware of existence of the internal jugular venous valve. This is the only valve between the right atrium of the heart and the brain, and it has an important role of preventing retrograde blood flow and increased back pressure to the brain. In this study, anatomic appearance of human internal jugular valves is described, and the competence of these valves is assessed. We examined also a safe approach to percutaneous cannulation of the internal jugular vein to avoid this complication. In the cadaveric subjects, the internal jugular vein with its valve was removed at the time of autopsy. In the living subjects, to examine the movement of this valve, endoscopic visualization utilizing the superfine fiberscope, and ultrasound techniques were applied. Next, to detect the competence of the jugular venous valve, transvalvular pressure gradients were measured. Nineteen internal jugular valves were obtained from 20 cadaveric subjects. These valves were situated directly above the termination of the internal jugular vein into the inferior bulb. The opening and closing of the valve were easily visualized with both superfine fiberscope and real-time ultrasound technique. Patients with competent valves showed transvalvular pressure gradients of 50-100 mmHg during cough-induced high intrathoracic pressure. Internal jugular venous valve is located 0.5-2.0 cm above the union of the subclavian and internal jugular veins, and the central approach performed at the summit of the cervical triangle has been shown to have a risk of injuring the internal jugular venous valve.(ABSTRACT TRUNCATED AT 250 WORDS)