Manual Occlusion of the Internal Jugular Vein during Subclavian Vein Catheterization: A Maneuver to Prevent Misplacement of Catheter into Internal Jugular Vein

Bedside technique to detect misplaced sub-clavian vein catheter in internal jugular vein

“…[2] Coriat et al, investigated 51 vascular surgical patients that were chronically treated for hypertension with either captopril or enalapril. [3] For the patients whose ACEI therapy was withheld the evening before surgery, the incidence of induction-induced hypotension was significantly less. Maintenance of therapy in patients chronically treated with ACEIs until the day of surgery may increase the probability of hypotension at induction.…”

“…Various methods for the identification of such events have been described; ipsilateral head turning and supraclavicular pressure, [1] keeping the guidewire J-tip directed downward, [2] and manual occlusion of the ipsilateral IJV at the time of insertion of guidewire. [3] Similarly, saline flush test [4] has also been used for bedside detection of the misplaced catheter. Despite all these reports, the problem of misplacement remains.…”

“…The concern among those who recommend holding therapy is that pharmacologic suppression of ACEI in patients undergoing general anesthesia may lead to severe hypotension, refractory to fluid therapy and requiring vasopressors. [1][2][3] On the other hand, if complications are no more likely when continuing one of these agents up to the day of surgery, withholding ACEI could represent an unnecessary and potentially harmful complication such as postoperative hypertension or simply forgetting to restart the medication postoperatively. Although several studies have attempted to address this dilemma, a systematic and comprehensive summary of the pertinent evidence has not been published.…”

“…Although several studies have attempted to address this dilemma, a systematic and comprehensive summary of the pertinent evidence has not been published. [3] Several cases of hypotension have been reported in patients receiving ACEI prior to surgery, suggesting that interactions between ACEIs and anesthesia may be neither beneficial nor predictable. [2] Coriat et al, investigated 51 vascular surgical patients that were chronically treated for hypertension with either captopril or enalapril.…”

Central venous catheter misplacement and the guidewire

“…A manoeuvre to prevent misplacement of subclavian CVC into ipsilateral internal jugular vein due to guide wire deflection has been described. [5] Manual occlusion of ipsilateral internal jugular vein in the supraclavicular area during guide wire insertion has been found to be effective in preventing such misplacements. Finally, electrocardiography guidance during insertion and image intensifier after insertion, as suggested by the authors, will detect these misplacements quickly and is mostly available.…”