Letters to the Editor
Central venous access is preferred and often required for large-volume intravascular infusions, potent vasoactive drug administration, and when peripheral venous access is unavailable (1). Fabian et al. (2) described the technique and efficacy of double internal jugular vein cannulation in adult and pediatric cardiac surgery patients by using a double venipuncture approach. Harte et al. (3) went one step further and described double internal jugular vein cannulation in adult patients using a single venipuncture technique.
We describe a similar technique for cannulating the internal jugular twice after locating it only once. This technique was applied in a 60-yr-old woman scheduled to undergo emergency coronary artery bypass graft surgery. After placing the patient in the Trendelenburg position, appropriate anatomical landmarks were identified for cannulating the internal jugular vein via the anterior approach. In this particular case, an 8.5F sheath was introduced over a 0.035 inch diameter guidewire. Through this 8.5F sheath, a second 0.035 inch diameter guidewire was introduced and the sheath withdrawn. In the last step, a 14-gauge, 5 1/4-inch single-lumen cannula was introduced over one of the guidewires while an 8.5F sheath was introduced over the other. The guide wires were subsequently withdrawn (Figure 1).
This catheter insertion technique provides rapid double cannulation of the internal jugular vein after the insertion of a single seeker needle. Limitations of this technique include bleeding from the original 8.5F sheath site. Bleeding was controlled in this case with a pressure dressing and application of oxidized regenerated cellulose (surgicel) around the cannulation site.
This can be an approach for rapid central access when peripheral IV access has failed. Other advantages of this technique include less patient discomfort and reduced risks of pneumothorax and carotid artery puncture with local hematoma formation because a single venipuncture is used (3).
A. D. Sharma
MD N. P. deBruijn MD
1. Wilson JN, Grow JB, Demong CV, et al. Central venous pressure in optimal blood volume maintenance. Arch Surg 1962; 85:563–78.
2. Fabian JA, Jesudian MCS, Rah KH. Double internal jugular vein cannulation in pediatric and adult cardiac surgery patients: an easy and convenient technique. Anesth Analg 1986; 65:419–20.
3. Harte FA, Chalmers PC, Danker PR, Sheikh F. Double internal jugular vein cannulation in adult patients utilizing a single venipuncture. Anesth Analg 1987; 66:370–1.