Massive hemothorax following failed internal jugular vein access during an electrophysiological procedure: “Early detection – catastrophe averted”

Abstract Purpose To compare the safety and efficacy of left versus right internal jugular vein access for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with a small liver and short vertical puncture distance. Materials and Methods The vertical distance from the hepatic vein orifice to the puncture point of the portal vein was measured by CT and DSA. A distance ≤ 30 mm is defined as a short vertical puncture distance. After 1:1 propensity score matching (PSM), 29 patients of left internal jugular vein-TIPS (LIJ-TIPS) and 29 patients of right internal jugular vein-TIPS (RIJ-TIPS) were included. The number of needle punctures, fluoroscopy time, and radiation dose during the puncture process were statistically analyzed. Results There was no significant difference in the average vertical puncture distances on CT or DSA between LIJ-TIPS and RIJ-TIPS (19.10 ± 0.60 mm vs. 19.30 ± 0.60 mm, P = 0.840; 22.02 ± 0.69 mm vs. 22.23 ± 0.64 mm, P = 0.822, respectively). The average number of needle punctures, fluoroscopy time, and radiation dose in LIJ-TIPS were significantly lower than those in RIJ-TIPS (2.07 ± 0.20 vs. 4.10 ± 0.24, P < 0.001; 78.45 ± 12.80 s vs. 201.16 ± 23.71 s, P < 0.001; 31.55 ± 7.04 mGy vs. 136.69 ± 16.38 mGy, P < 0.001, respectively). Within three punctures, the technical success rate in LIJ-TIPS was significantly higher than that in RIJ-TIPS (86.2 vs. 27.6%, P < 0.001). The incidence of hemoperitoneum in LIJ-TIPS was significantly lower than that in RIJ-TIPS (0% vs. 13.8%, P = 0.038). Conclusion The left internal jugular vein could be used as primary access for TIPS creation in patients with a small liver and short vertical puncture distance.

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Ultrasound guided internal jugular vein access in children and infant: A meta-analysis of published studies

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2009.03171.x ◽

2009 ◽

Vol 19 (12) ◽

pp. 1199-1206 ◽

Cited By ~ 86

Author(s):

STEPHANIE SIGAUT ◽

ALIA SKHIRI ◽

IDA STANY ◽

JONATHAN GOLMAR ◽

YVES NIVOCHE ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Meta Analysis ◽

Ultrasound Guided ◽

Vein Access

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Routine use of ultrasound to guide internal jugular vein access in children

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2010.03345.x ◽

2010 ◽

Vol 20 (8) ◽

pp. 777-778 ◽

Cited By ~ 4

Author(s):

David Faraoni

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Vein Access

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Ultrasound-guided anatomical evaluation and percutaneous cannulation of the right internal jugular vein in infants <4000 g

The Journal of Vascular Access ◽

10.1177/1129729819845620 ◽

2019 ◽

Vol 21 (1) ◽

pp. 92-97 ◽

Cited By ~ 1

Author(s):

Filiz Uzumcugil ◽

Aysun Ankay Yilbas ◽

Basak Akca

Keyword(s):

Carotid Artery ◽

Real Time ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Anatomical Variation ◽

Complication Rates ◽

Success Rates ◽

Ultrasound Guided ◽

Vein Access ◽

The Right

Background: The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. Aim: The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. Materials and methods: A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. Results: The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. Conclusion: Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.

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