Cannulation needle-induced anterior wall tenting of internal jugular vein causing posterior wall penetration

Abstract

Unintentional posterior venous wall penetration during internal jugular vein (IJV) cannulation may cause critical arterial injuries in spite of ultrasound guidance. We aimed to evaluate whether small venous diameter and anterior venous wall tenting by a needle would be associated with posterior venous wall penetration, and to seek factors related to the venous wall tenting. We conducted a retrospective review in patients who underwent IJV cannulation. Using an ultrasound view obtained when puncturing, venous diameter, venous wall thickness, anterior venous wall tenting length, and needle angle were measured, and posterior venous wall penetration was determined. Eleven cannulations in 56 patients were assigned to posterior venous wall penetration. Small venous diameter (p = 0.004), and long anterior venous wall tenting (p = 0.007) were associated with posterior venous wall penetration. The longer anterior venous tenting would be expected with reducing needle angle (p = 0.004) or increasing anterior venous wall thickness (p = 0.006). In conclusion, small IJV and anterior venous wall tenting lead to posterior venous wall penetration. Anterior venous wall tenting is longer with reducing needle angle, or increasing the anterior venous wall thickness.

Sono-anatomical analysis of right internal jugular vein and carotid artery at different levels of positive end-expiratory pressure in anaesthetised paralysed patients

“…[ 12 ] Small IJV and anterior venous wall tenting lead to posterior venous wall penetration and may cause critical arterial injuries in spite of ultrasound guidance. [ 13 ] As observed in our study, application of PEEP can increase venous pressure and thereby reduce collapsibility of IJV. The decrease in collapsibility and increase in AP diameter may reduce IJV anterior wall indentation and unrecognised puncture of the posterior vessel wall.…”

Internal Jugular Vein Cannulation Using a 3-Dimensional Ultrasound Probe in Patients Undergoing Cardiac Surgery: Comparison Between Biplane View and Short-Axis View

“…The incidence of posterior wall puncture in the SAX group in the present study was similar to that of previous studies. 13 The proposed mechanism for the accidental puncture of the posterior wall is a result of various factors, 2,14 including smaller diameter of the IJV, speed and angle of needle insertion, loss of needle path during insertion, and the distance between the needle entry point and transducer margin. Although the incidence of posterior wall puncture cannot be absolutely eliminated, it can be reduced significantly puncturing the vein during biplane imaging.…”

Comparison of three ultrasound views for internal jugular venous cannulation in patients undergoing cardiac surgery: A randomized trial

“…Yoshida et al . [ 19 ] reported that patients with small IJV diameter and long anterior venous wall tenting are the risk factors for posterior wall puncture.…”