August 2000 - Volume 93 - Issue 2 - pp 319-324
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.§
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.
Those percentages are higher than I'd have expected. This harkens back to the concern that in a randomized controlled trial, the sham patients will get some possible treatment of their valvular stenoses just by having the catheter run through them.