Clinically Silent Venous Thrombosis Following Internal and External Jugular Central Venous Cannulation in Pediatric Cardiac Patients

Moore, Roger A.; McNicholas, Kathleen W.; Naidech, Howard; Flicker, Stephanie; Gallagher, John D.

doi:10.1097/00000542-198505000-00018

Cited by 48 publications

(19 citation statements)

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“…That a curve in the catheter increases the contact between catheter and vessel wall has already been considered by Moore et al [22] in humans. The sharper angle of the right subclavian vein when it turns into the superior vena cava was considered an important risk factor for vessel injury after subclavian catheterization by Robinson et al [23].…”

Section: Discussionmentioning

confidence: 58%

Intimal Hyperplasia after Long-Term Venous Catheterization

Xiang

Verbeken²,

Lommel³

et al. 2000

Eur Surg Res

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Objective: Intimal hyperplasia is a well-known consequence of arterial injury and arterialization in vein grafts. However, the subacute and chronic vein wall changes which occur after catheterization have not been well studied. In this animal study, intimal hyperplasia in the vein wall after catheterization was examined. Methods: A silicon catheter was placed in the anterior caval vein of 54 rats. After in situ fixation at scheduled intervals (1 day to 6 months), the pathologic changes in the vein wall were studied on semi-serial histology sections by means of light microscopy. Results: Three forms of intimal hyperplasia could be observed: plaque-like, papillary-like and incorporation of the mural part of the sleeve into the underlying vein wall. Although the appearance of each was different, their composition was identical. All were mainly composed of α-actin-positive cells and collagen localized above the internal elastin layer, and covered by endothelium if facing the lumen. The plaque-like and papillary-like forms were mainly localized in the anterior vena cava, while sleeve incorporation mainly occurred in the jugular vein. Plaque-like and papillary-like intimal hyperplasia could be seen together on the same slide, but these two forms were never seen together with sleeve incorporation. Conclusion: Intimal hyperplasia occurs after venous catheterization and is probably caused by chronic injury to the vein wall due to knocking and rubbing movements of the catheter against the wall.

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Section: Discussionmentioning

confidence: 58%

Intimal Hyperplasia after Long-Term Venous Catheterization

Xiang

Verbeken²,

Lommel³

et al. 2000

Eur Surg Res

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“…Although the risk of thrombosis is present even with an external jugular vein cannula [8], a thrombus in the external jugular vein may be limited in extent due to the presence of valves in this vein. Moreover, the intracranial pressure will not rise and the Fontan circulation will not fail even if there is a thrombus in the external jugular vein.…”

Section: Discussionmentioning

confidence: 99%

A comparison of external and internal jugular venous pressures to monitor pulmonary artery pressure after superior cavopulmonary anastomosis

Malik

Chauhan

Vijayakanthi

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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The internal jugular vein continues to be the preferred site for cannulation to monitor central venous pressure despite the reported evidence of the accuracy of external jugular venous pressure (EJVP) to reliably predict internal jugular venous pressure (IJVP). Internal jugular venous cannulation carries a risk of thrombosis that can be life-threatening in children undergoing superior cavopulmonary anastomosis and a subsequent Fontan procedure. The present study compared IJVP and EJVP in children undergoing superior cavopulmonary anastomosis and found no statistical and clinical difference between IJVP and EJVP. Thus, external jugular vein cannulation reliably predicts IJVP and pulmonary artery pressures in children undergoing superior cavopulmonary anastomosis, and may obviate the risk of life-threatening cavopulmonary thrombosis.

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“…Thrombosis has been demonstrated to be associated with the placement of a central line. 158 At least 20% of children with heart disease and central venous or arterial lines have been demonstrated to develop line-related thrombosis, 159,160 hypothesized to occur as a result of damage to the endothelium caused by line placement and infusate administration. 158 Although not studied in children, adults with cardiomyopathy have been demonstrated to have increased markers of coagulation activation, including fibrinopeptide A (a protein produced during ongoing coagulation when fibrinogen is changed to fibrin) and thrombin-antithrombin complexes (complexes produced during ongoing coagulation when antithrombin neutralizes thrombin).…”

Section: Abnormalities In Vessel Wall Integritymentioning

confidence: 99%