Related Experiment Videos
The effect of right internal jugular vein cannulation on intracranial pressure
R P Woda1, M E Miner, C McCandless
1Department of Anesthesiology, Ohio State University, Columbus, USA.
Insights
Right internal jugular vein cannulation for central venous access does not elevate intracranial pressure in neurocritical care patients. This study confirms its safety in managing patients at risk of intracranial hypertension.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Vascular Access
Background:
- Central venous access is vital for managing patients with elevated intracranial pressure.
- The internal jugular vein approach has been questioned for potentially increasing intracranial pressure.
Purpose of the Study:
- To prospectively evaluate the impact of right internal jugular vein cannulation on intracranial pressure.
- To assess the safety of this approach in patients at risk of intracranial hypertension.
Main Methods:
- Eleven neurocritical care patients requiring intracranial pressure monitoring and central venous access were studied.
- Intracranial pressure was recorded before and after right internal jugular vein cannulation, with and without the Queckenstedt maneuver.
- Statistical analysis using single-factor analysis of variance was performed.
Main Results:
- No significant differences in heart rate, cerebral perfusion pressure, or blood pressures were observed.
- No statistically significant difference was found in intracranial pressure measurements at any time point.
- The percentage change from baseline intracranial pressure remained consistent throughout the study.
Conclusions:
- Cannulation of the right internal jugular vein is a safe method for central venous access in patients at risk of intracranial hypertension.
- Potential accommodating mechanisms for maintaining stable intracranial pressure are discussed.
Abstract:
Access to the central venous circulation is often necessary in patients who have elevated intracranial pressure. It has been suggested that a disadvantage of the internal jugular vein approach to the central circulation may be an elevated intracranial pressure. The purpose of this prospective study was to evaluate the effect of right internal jugular vein cannulation on intracranial pressure in patients who are at risk of intracerebral hypertension. Eleven adult patients studied in the intensive care unit were evaluated. The population included those patients who were admitted to the neurosurgical intensive care unit requiring intracranial pressure monitoring and central venous access. With the intracranial pressure monitor in place, patients were put in supine and 30 degrees head-up positions while intracranial pressure was recorded. The Queckenstedt maneuver was performed on all patients. A central venous line was then placed in the right internal jugular vein, and intracranial pressure was recorded. The Queckenstedt maneuver was again performed in the study population, and intracranial pressure measurements were recorded for the right, left, and bilateral compression of the internal jugular vein. The results of the intracranial pressure measurements before and after placement of the central venous line were statistically analyzed using single-factor analysis of variance over time. The mean Glasgow coma and Apache II scores for the study groups were 8 +/- 4 and 15 +/- 6, respectively. There were no significant differences in heart rate; cerebral perfusion pressure; or systolic, mean, or diastolic pressures throughout the study period. There was no statistical difference found between the intracranial pressures at any time point throughout the study. Furthermore, no difference was found in percentage change from baseline intracranial pressure data throughout the study period. Our results suggest that cannulation of the right internal jugular vein is a safe approach to the central circulation in patients at risk of intracranial hypertension. A description of the possible accommodating mechanisms are outlined.