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Published on: December 23, 2014
Arterial vessels behind the right internal jugular vein with relevance to central venous catheterisation
Manik Chandra1, Sarah Start2, David Roberts2
1Department of Anaesthesia, Leeds General Infirmary, Leeds, UK.
Insights
Ultrasound and cadaveric studies reveal numerous arterial vessels close to the right internal jugular vein, highlighting risks during cannulation. Awareness and imaging can prevent serious complications like arterial damage.
Area of Science:
- Vascular anatomy and interventional procedures.
Background:
- Right internal jugular vein cannulation is a common procedure.
- Complications can arise from posterior wall transfixion and damage to adjacent vessels.
- The proximity of subclavian artery branches is often underestimated compared to the carotid artery.
Purpose of the Study:
- To provide clinically relevant images of at-risk vessels posterior to the right internal jugular vein.
- To emphasize the close proximity of these arteries.
- To offer strategies for avoiding potential complications during cannulation.
Main Methods:
- Ultrasound examination of 24 patients.
- Cadaveric dissections to illustrate vascular anatomy.
- Analysis of arterial vessel proximity to the right internal jugular vein at multiple anatomical levels.
Main Results:
- Numerous arterial vessels, excluding the carotid, were identified within 8.0 mm of the right internal jugular vein's posterior wall.
- Cadaveric dissections confirmed close proximity of multiple subclavian artery branches.
- Vulnerable branches include the thyrocervical trunk, inferior thyroid, and vertebral arteries.
Conclusions:
- Inferior approaches for right internal jugular vein cannulation increase the risk to arterial branches.
- High-resolution ultrasound can visualize these arteries prior to cannulation.
- Identifying and avoiding these vessels is crucial to prevent vein transfixion and arterial damage.
Abstract:
During right internal jugular vein cannulation, complications can arise due to transfixion of the posterior wall and damage to other vessels. The risks to the subclavian artery and its branches are less well appreciated than the carotid artery. Example images are lacking in the literature. Using ultrasound and cadaveric studies, we aim to provide clinically relevant images of at-risk vessels posterior to the right internal jugular vein to emphasise their close proximity, and provide strategies to avoid potential complications. Using ultrasound in 24 patients, we found the presence of numerous arterial vessels (excluding the carotid) within 8.0 mm of the posterior wall of the right internal jugular vein at the levels of the mastoid, cricoid and supraclavicular region. Cadaveric dissections further highlighted the close proximity of numerous branches of the subclavian artery. Vulnerable branches of the subclavian artery include the thyrocervical trunk, inferior thyroid and vertebral arteries. More inferior approaches to right internal jugular vein cannulation are likely to put more arterial branches at risk. Higher resolution ultrasound enables visualisation of these arteries prior to cannulation. If identified, measures should be taken to avoid vein transfixion and arterial damage.
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