Idiopathic unilateral hypoplasia of internal jugular vein and coagulopathy: Unusual case for central venous catheterization

Abstract

Central venous catheterization (CVC) is routinely done procedure in ICU or during surgery for various indications. Right Internal jugular vein (IJV) is preferred vessel among different routes for CVC. Anatomic variations of neck vessels are not uncommon and may increase the complication rate especially in patients with altered coagulation profile. Anatomic landmark technique is commonly used for CVC but not without possibility of complications. Ultrasound (US) guided IJV Cannulation provides high success rate, less access time and lesser complications. Superiority of US over anatomic landmark technique has been established, but use of US in clinical practice is still limited. We report a case of idiopathic unilateral hypoplastic IJV in a patient with altered coagulation profile who required CVC, we also tried to find out the barriers for limited use of US.

Towards Optimal Central Venous Catheter Tip Position

“…Since the first placement by Forßmann in 1929, chest radiography has been used to verify CVC position. Today, the American College of Radiology recommends portable radiographs for critically ill patients following placement of support and monitoring devices such as endotracheal tubes, CVCs, etc [4,8]. Bedside chest radiography differs from standard erect radiography in several critical respects.…”

“…We suggest placing the CVC tip at the maximal P wave amplitude, as CVCs typically end in the lower SVC at junction with the right atrium. At this position catheters -even those inserted from the left -will run parallel to the vessel wall [8,18].…”

“…Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning [4,8]. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter [4,8].…”

“…In addition to insertion complications, the optimal CVC tip position remains the subject of debate because no position is considered to be absolutely safe [7]. Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel or position [4,8].…”