damage to valves during cannulation and catheterization
Posted: Tue Sep 04, 2012 10:51 am
http://journals.lww.com/anesthesiology/ ... _Is.7.aspx
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.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.