Letters to the Editor
To the Editor:
Central venous cannulation via the external jugular vein (EJV) is a recognized technique [1-3]. It is associated with minimal complications but with a relatively frequent failure rate compared with the cannulation of the internal jugular or subclavian veins (SCV) [1,3,4]. The use of the Seldinger J-wire increased successful central venous cannulation via the EJV from 50% to 79%-90% [2-4]. Cannulation failures are, in part, due to the difficult passage of the J-wire through the EJV-SCV junction into the thorax . Variations of the termination and angulation of the EJV as it enters the SCV and the distribution and morphology of the valves in the EJV contribute to this difficulty [2-7]. We describe a technique that facilitates the placement of a 7F triple-lumen catheter (TLC) via the EJV when the J-wire could not transverse the EJV-SCV junction.
In 11 of 68 EJV cannulation attempts, we found that the J-wire could not transverse the EJV-SVC junction, as evidenced by resistance to further wire advancement. We withdrew the J-wire approximately 0.5 cm proximal to the junction and advanced the TLC over the J-wire. We found that the TLC negotiated through the venous junction pass the guide wire and entered the SVC without difficulty. The success of this technique may lie in the difference of the width of the tip of the J-wire (6-8 mm) and the TLC catheter (1-2 mm) (Figure 1). The diameter of EJV-SCV junction is 5.5 +/- 1.6 mm . The tip may be too wide to negotiate through the venous junction, but the smaller TLC allows passage without difficulty.
We have found that the use of this rescue technique facilitated central vein cannulation through the EJV in 10 of 11 attempts.
Alvaro M. Segura-Vasi, MD
Melody D. Suelto, MD
Arthur M. Boudreaux, MD
Department of Anesthesiology; University of Alabama in Birmingham; Birmingham, AL 35233-6810
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