Year : 2013  |  Volume : 16  |  Issue : 3  |  Page : 224--225

Anatomical landmark technique for internal jugular vein cannulation in patients with cyanotic congenital heart disease: A word of caution


Samarjit Bisoyi 
 Department of Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar, Odisha, India

Correspondence Address:
Samarjit Bisoyi
Department of Cardiac Anesthesiology, Apollo Hospitals, Sainik School Road, Bhubaneswar - 751 005, Odisha
India




How to cite this article:
Bisoyi S. Anatomical landmark technique for internal jugular vein cannulation in patients with cyanotic congenital heart disease: A word of caution.Ann Card Anaesth 2013;16:224-225


How to cite this URL:
Bisoyi S. Anatomical landmark technique for internal jugular vein cannulation in patients with cyanotic congenital heart disease: A word of caution. Ann Card Anaesth [serial online] 2013 [cited 2020 Sep 27 ];16:224-225
Available from: http://www.annals.in/text.asp?2013/16/3/224/114241


Full Text

The Editor,

The original article, "The success rate and safety of internal jugular vein cannulation using anatomical landmark technique in patients undergoing cardiothoracic surgery" by Tempe et al., is commendable. [1] The authors highlighted the importance of developing and preserving the skill to access central venous cannulation by landmark technique. Accidental carotid artery puncture and its cannulation is one of the most feared complications of internal jugular vein cannulation. Many patients with cyanotic congenital heart disease have very high hematocrit. While cannulating the central vein by the anatomical landmark technique; we rely on the color of blood and the pulsatility of the backflow through the needle. In such cyanotic patients, inadvertent carotid artery puncture may be catastrophic. [2],[3] This is because dark color of blood (low oxygen saturation) is misleading; and due to the high viscosity the pulsatility of backflow may be poorly appreciated. Especially in an inexperienced hand this can lead to the next step in central venous cannulation, i.e., dilatation over the guide wire (Seldinger Technique). Moreover, patients with cyanotic heart disease have coexisting coagulopathy. [4],[5] Thus, accidental carotid artery puncture may end up in severe blood loss necessitating surgical repair of the injury and cancellation of the planned surgical procedure.

The practice guideline for central venous access by the American Society of Anesthesiologists recommends non reliance on the blood color and pulsatility to confirm venous placement of the access needle. It recommends manometry, real-time ultrasound, pressure wave-form transduction or blood gas analysis for this purpose. [6] However in cyanotic patients even blood gas analysis may be misleading. Therefore, it would be prudent to use real-time ultrasound for confirming venous placement of the needle in such subset of patients. Using the anatomical landmark technique for internal jugular vein cannulation does help in developing the judgment, experience and skill of the anesthesiologist. However, in patients with cyanotic heart disease with high hematocrit, real-time ultrasound would be a judicious modality to avoid inadvertent carotid artery puncture and its complications.

References

1Tempe DK, Virmani S, Agarwal J, Hemrajani M, Satyarthy S, Minhas HS. The success rate and safety of internal jugular vein cannulation using anatomical landmark technique in patients undergoing cardiothoracic surgery. Ann Card Anaesth 2013;16:16-20.
2Guilbert MC, Elkouri S, Bracco D, Corriveau MM, Beaudoin N, Dubois MJ, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J VascSurg 2008;48:918-25.
3Powell H, Beechey AP. Internal jugular catheterisation. Case report of a potentially fatal hazard. Anaesthesia 1990;45:458-9.
4Tempe DK, Virmani S. Coagulation abnormalities in patients with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth 2002;16:752-65.
5Horigome H, Hiramatsu Y, Shigeta O, Nagasawa T, Matsui A. Overproduction of platelet microparticles in cyanotic congenital heart disease with polycythemia. J Am Coll Cardiol 2002;39:1072-7.
6American Society of Anesthesiologists Task Force on Central Venous Access, Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, et al. Practice guidelines for central venous access: A report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2012; 116:539-73.