Complications of internal jugular vein catheterization

Percutaneous cannulation of the internal jugular vein has become a widely accepted method for monitoring central venous pressure, hyperalimentation, and rapid fluid administration. Although complications from this procedure have been rare, many unusual case reports are found in the literature. Three cases of otolaryngologic importance are presented. A revised technique of the internal jugular vein catheterization is described.     

Thrombophlebitis of the internal jugular vein secondary to pharyngitis

A case of septic thrombophlebitis of the internal jugular vein after pharyngitis is reported. Because of the common use and effectiveness of antibiotics against throat infections, this complication is now rarely seen. This condition has characteristic signs and symptoms, and a diagnosis can be obtained when the physician is aware of these characteristics. Radionuclide scan and Doppler effect flow studies of the internal jugular vein are useful diagnostic adjuncts. If recognized early and treated promptly with antibiotics, resolution is the rule. The literature has been reviewed.     

A new way of access into the internal jugular vein

This paper describes a new technique for the canulation of the internal jugular vein. A transsection of the neck at the level of C4 (upper border of the thyroid cartilage) (Figure 1) shows the relative position of the internal jugular vein, the carotid artery and the sternocleidomastoid muscle. The internal jugular vein at this level is more superficial than is usually imagined. A cutaneous point of entry placed at the level of the thyroid cartilage on the medial border of the sternocleidomastoid muscle would be directly above, at the zenith of the carotid artery. From that point, moving a needle externally hugging the posterior aspect of the muscle will make it possible to reach the vein while actually moving away from the carotid artery.     

Sonographic guidance when using the right internal jugular vein for central vein access

From January 1986 to March 1993, 29 patients aged between 40 and 60 years with primary high grade osteosarcoma of the extremity were treated at Rizzoli Institute with neoadjuvant chemotherapy. Before surgery patients received cisplatin and adriamycin. Postoperatively, patients with a good histologic response received the same two drugs preoperatively used, while in case of poor response ifosfamide and etoposide were added to cisplatin and adriamycin. Twenty-five patients (86%) were surgically treated with a limb salvage, whereas 4 patients (14%) were amputated. With a median follow-up of 8 years (5-12), the 8-year event-free survival was 57% and the 8-year overall survival was 62%. No chemotherapy-related deaths were recorded and toxicity was manageable. These results are significantly better than those achieved in 24 patients of the same age, treated at Rizzoli Institute between 1975 and 1985 only with surgery (87% of amputation and 17% of 8-year event-free and overall survival) and indicate an advantage for the use of neo-adjuvant chemotherapy also in patients with high grade osteosarcoma of the extremity older than 40 years.     

Reconstruction of the iliofemoral venous circulation using internal jugular vein autograft

Two patients with recurrent tumour masses in the groin which involved the common femoral vessels underwent en bloc resection of the tumour, vessels and adjacent anterior abdominal wall. Arterial reconstruction used autologous saphenous vein or polytetrafluorethylene graft. Venous reconstruction was with autologous internal jugular vein.     

Complications in surgical treatment of varicose veins of the lower limbs and their prevention]

To prevent hemorrhage and hematomas in the bed of subcutaneously removed large saphenous vein after Babcock the authors somewhat modified tactically the order of manipulations during the operative procedure. This method was employed while operating 42 patients with primary and secondary venous varices. It was feasible to prevent hemorrhage and hematomas along the vascular bed in every case. The suggested tactical modification of the removal of venous varices wound improve the postoperative course and shorten the terms of patients' stay at the hospital postoperatively.     

Recurrent varicose veins in the groin after surgery

Bloom syndrome (BLM) is a genetic disorder associated with predisposition to cancer and chromosome instability. However, the most readily recognized clinical feature of the syndrome is growth retardation. Introduction of the previously cloned BLM gene into BLM cells yielded correction of the chromosome instability and slow growth phenotypes. Additionally, asynchronous cultures of complemented clones revealed a lower percentage of cells in S-phase than uncomplemented BLM cells. These results support the notion that BLM is a defect in which short stature, chromosome instability and cancer predisposition are all associated with an error in DNA replication.     

Air bubbles in the subclavian or internal jugular veins: a common finding on contrast-enhanced CT

BACKGROUND: Foot complications in diabetes incur huge human and medical costs. There is a high incidence of complicated diabetes mellitus in Far North Queensland, particularly in the indigenous communities. METHODS: An audit of 51 patients admitted to Cairns Base Hospital from July 1992 to December 1994 with diabetic foot complications requiring surgical intervention was performed. RESULTS: The majority of surgical procedures were for serious infections in neuropathic feet precipitated by minor trauma. Surgical procedures included debridement/drainage, minor amputation, major amputation and arterial bypass. Half of the patients required more than one procedure and/or multiple admissions. Average length of stay was 48 days. Indigenous patients were overrepresented in this audited group. CONCLUSIONS: Prevention or minimization of diabetic foot complications can be achieved only through improvement in education and vigilance at all levels of the treatment process from community to hospital. Special attention to the needs of indigenous communities with a high incidence of diabetes must be a feature of any future initiatives.