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Anesthesiology:

August 2000 - Volume 93 - Issue 2 - pp 319-324

Clinical Investigations

Competence of the Internal Jugular Vein Valve Is Damaged by Cannulation and Catheterization of the Internal Jugular Vein

Wu, Xianren M.D.*; Studer, Wolfgang M.D.†; Erb, Thomas M.D.†; Skarvan, Karl M.D.‡; Seeberger, Manfred D. M.D.§

Abstract

Background: Experimental results suggest that the competence of the internal jugular vein (IJV) valve may be damaged when the IJV is cannulated for insertion of a central venous catheter. It has further been hypothesized that the risk of causing incompetence of the proximally located valve might be reduced by using a more distal site for venous cannulation. The present study evaluated these hypotheses in surgical patients.

Methods: Ninety-one patients without preexisting incompetence of the IJV valve were randomly assigned to undergo distal or proximal IJV cannulation (≥ 1 cm above or below the cricoid level, respectively). Color Doppler ultrasound was used to study whether new valvular incompetence was present during Valsalva maneuvers after insertion of a central venous catheter, immediately after removal of the catheter, and, in a subset of patients, several months after catheter removal, when compared with baseline findings before cannulation of the IJV.

Results: Incompetence of the IJV valve was frequently induced both by proximal and distal cannulation and catheterization of the IJV. Its incidence was higher after proximal than after distal cannulation (76%vs. 41%;P < 0.01) and tended to be so after removal of the catheter (47%vs. 28%;P = 0.07). Valvular incompetence persisting immediately after removal of the catheter did not recover within 8–27 months in most cases.

Conclusions: Cannulation and catheterization of the IJV may cause persistent incompetence of the IJV valve. Choosing a more distal site for venous cannulation may slightly lower the risk of causing valvular incompetence but does not reliably avoid it.