Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Modeling Blood Flow in Veins of Uniform Properties (Giraffe Jugular Vein)

This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.

Application of the “Three Threes” Method in Clinical Teaching of Internal Jugular Vein Puncture

Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.

Thoracic duct cannulation during left internal jugular vein cannulation:A case report

BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.

Thrombosis of the internal jugular vein,a rare entity:A case report and brief review of the literature

Rationale:Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms.If present,the symptoms are frequently manifested as a sensation of pain and cervical tension.Its etiology is variable,including trauma,central catheterization,and hypercoagulable states,among others.Patient’s Concern:A 41-year-old female,previously healthy,was admitted to the emergency room for worsening pain in the left cervical area of 5 d.Previously,she was treated for suspected acute pharyngotonsillitis yet without improvement.Diagnosis:Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating.Ultrasound study showed thrombosis of the left internal jugular vein.A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.Interventions:Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.Outcomes:The patient was discharged after 3 d of treatment with vitamin K antagonists.Lessons:Venous thrombosis at the level of the internal jugular vein is an infrequent entity.Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.

Internal Jugular Vein Graft after Inadvertent Severing of the Internal Carotid Artery during Carotid Endarterectomy and an Urgent Re-Exploration for Immediate Post-Operative Wound Site Bleeding: A Case Report

Carotid endarterectomy is a well-established treatment for preventing stroke in selected patients. Although there is debate over whether patch angioplasty or primary closure should be used to reconstruct the bifurcation after carotid endarterectomy, there is growing evidence in the literature in favor of patch angioplasty. When compared to primary closure, patch angioplasty during conventional carotid endarterectomy is suggested to lower the incidence of restenosis and recurrent ipsilateral stroke. Various materials have been used as a patch in this procedure, including the saphenous vein, synthetic patches, or less frequently, an internal jugular vein patch where extensive narrowing of the internal carotid artery is evident. In our case, we used an internal jugular vein graft after inadvertent severing the internal carotid artery (ICA) during carotid endarterectomy after the failure of reconstruction with a saphenous vein patch. We also encountered immediate postoperative reactionary hemorrhage following anesthetic reversal, necessitating an urgent re-exploration. The purpose of this case report is neither an attempt to suggest all patients need angioplasty nor to state that an internal jugular vein patch or graft is superior to synthetic material or saphenous veins;rather, it is an attempt to emphasize a potentially effective rescue way to reconstruct inadvertent extensive vascular injury during carotid endarterectomy.

Jugular Bulb Diverticulum: A Rare Cause of Pulsatile Tinnitus and Literature Review

Objectives: Pulsatile tinnitus involves a wide spectrum of etiologies. The etiologies include normal vascular variants, temporal bone tumor, acquired vascular lesions and chronic middle ear inflammatory diseases. Jugular bulb diverticulum is a rare cause of pulsatile tinnitus. We report one case of jugular diverticulum presenting with pulsatile tinnitus and its surgical management and outcome. Case Report: A 36-year-old woman with a history of uterine myoma and chronic anemia presented with right pulsatile tinnitus that was worsening in recent one month. Neurological exam was normal. ENT evaluation revealed no abnormalities via otoscopy and physical examination. The CT scan revealed right dominant jugular bulb with diverticulum projecting to posterior ear canal wall. We performed jugular bulb diverticulum resurfacing with temporalis fascia, Surgicel® and Gelfoam®, and bone wax via transmastoid approach. The symptom improved postoperative immediately. No major complications were noted during outpatient clinic follow-up. Conclusion: Transmastoid resurfacing of jugular bulb diverticulum is an effective management of pulsatile tinnitus from this kind vascular anomaly.

Pulmonary embolism and internal jugular vein thrombosis as evocative clues of Lemierre's syndrome:A case report and review of the literature

Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.

Surgical resection of rare internal jugular vein aneurysm in neurofibromatosis type 1

Neurofibromatosis type 1 is a congenital condition affecting neurons and connective tissue integrity including vasculature.On extremely rare occasions these patients present with venous aneurysms affecting the internal jugular vein.If they become large enough there presents a risk of rupture,thrombosis,embolization or compression of adjacent structures.In these circumstances,or when the patient becomes symptomatic,surgical exploration is warranted.We present a case of one of the largest aneurysms in the literature and one of only five associated with Neurofibromatosis type 1.A 63-year-old female who initially presented for a Hinchey Ⅲ diverticulitis requiring laparotomy developed an incidentally discovered left neck swelling prior to discharge.After nonspecific clinical exam findings,imaging identified a thrombosed internal jugular vein aneurysm.Due to the risks associated with the particularly large size of our patient's aneurysm,our patient underwent surgical exploration with ligation and excision.Although several techniques have been reported,for similar presentations,we recommend this technique.

Safety and Feasibility of the Venous Access via Internal Jugular Vein Puncture Approach for Totally Implantable Venous Access Device Placements Compared with Subclavian Vein Puncture

Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.

Malignant meningioma with jugular vein invasion and carotid artery extension:A case report and review of the literature

BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.

Jugular Venous Thrombosis, a Rare Location of the Embolic Thrombo Venous Disease about a Case in Guinea

Observation: This patient was a 40-year-old housewife with dysphonia, physical asthenia, palpitations, fever and cervical tumefaction that had been going on for 2 months, no known cardiovascular risk factor, such as medical history, ischemic stroke. Heart sounds were regular at 110 bpm, blood pressure = 120/80 mmhg, to the lungs there are sibilant rattles. Elsewhere, there is a painful left lateral cervical tumefaction febrile to the touch. Temperature = 38°C. The rest of the exam is peculiar. Conclusion: Jugular vein thrombosis is a rare variety of unusual localization of venous thromboembolism. It must be suspected in the presence of a painful cervical swelling and confirmed by magnetic resonance imaging or to scan with contrast or ultrasound. Anticoagulant therapy should be instituted as soon as possible to avoid the formidable complication of pulmonary embolism.

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy:a report and review of literature

Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one or more of cranial nerves IX,X,XI,and XII.We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve.The patient though later on had internal jugular vein thrombosis,which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis,and later on,to aggravate the therapy.With proper blood sugar control and appropriate long term antibiotics,not only that the patient is disease free at one year follow up,but the cranial nerve deficits also recovered.Apart from sharing the clinical and management details of this patient,we have reviewed the relevant literature in the discussion,which has shed some light onto some of the interesting facts about this condition and its prognosis.

A Retrospective Analysis for Different Routes of Administration in Mice-Percutaneous Retro-Orbital, Jugular Catheter, Tail Vein and Femoral Cut Down Injections

Liposomes effectively transport fatty proteins to targeted tissues. Laboratory experiments use multiple methods to administer liposomes, but comparison of these methods is not available. In this retrospective study, we characterized and compared four intravenous administration routes (tail vein, jugular catheter, femoral vein and percutaneous retro-orbital injections) in murine models. ApoE-/- mice were used to compare administration routes. Results indicate that the jugular catheter route delivered the highest amount of liposomes to tissues due to longer period of injections compared to other routes;however, this route failed to remain patent for 8/10 animals. Delivery via tail vein, femoral vein and percutaneous retro-orbital injections resulted in similar accumulation in the organs. When including technical difficulty and expense, percutaneous retro-orbital injections of liposomes are the most convenient and efficacious approach.

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance:A case report

BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.

Factors Predictive of Right Internal Jugular Vein Cross-Sectional Area Change in Response to Trendelenburg Positioning

Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.

Right Internal Jugular Vein Ectasia in African Woman: A Report of 2 Cases

Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. Accurate diagnosis from careful history, physical examination and radiological study can be made. We report here two cases of IJV ectasia in African adults with right lateral neck mass dilating when increase intrathoracic pressure. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJV ectasia as differential diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment. The asymptomatic case management of IJV ectasia is conservative with long-term surveillance.

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

The jugular venous pulse (JVP) waveform provides an insight into right heart function, and its assessment is important in patients with heart failure. However, the conventional pulse-transducer (contact) method for monitoring this waveform is not frequently used because it requires a high degree of skill. The aim of this study was to confirm the effectiveness of a prototype non-contact system that employs microwave radar (24 GHz, 7 mW;non-contact system) for JVP measurement. Experiments were conducted on eight healthy male volunteers (21.88 ± 0.99 years). JVP measurements were compared between the conventional contact method and the proposed non-contact method. Change in JVP waveform was measured in response to an angle of reclining in five steps from the supine position to 75° of elevation. The obtained JVP measurements were similar between the two methods. Because in the non-contact method the faint pulsation of the JVP is not suppressed by the pressure of a sensor placed on the skin, the prototype microwave radar system is particularly suitable for evaluating the JVP waveform.

Effect of different types of laryngeal mask airway placement on the right internal jugular vein: A prospective randomized controlled trial

BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has attracted an increasing amount of attention.AIM To investigate the effect of placement of different types of LMA(Supreme LMA,Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODS This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA(group 1), Guardian LMA(group 2), and I-gel LMA(group 3) groups. The main indicator was the overlap index(OI) of IJV and the common carotid artery(CCA)at the high, middle, and low points before and after the placement of the LMA.The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTS Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points(P< 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point(P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups(P < 0.05), and the proportion in group 2 was higher than that in group 3(P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2(P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of the IJV significantly increased, while the blood flow velocity significantly decreased(P <0.01). There was no significant difference among the three groups.CONCLUSION The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.

Effect of Head Position Angles on the Blood Flow in the Jugular Vein of Giraffes

The study investigated the effect of the angular position of the head on the blood flow in the jugular vein of giraffes. The vein considered is elastic and collapsible such that its cross-sectional area is not uniform. Transmural pressure causes the blood to move along the vein. Mathematical equations describing the flow were developed, and the vein was considered to be inclined at an angle φ to the horizontal. A finite-difference scheme was used to solve the equations of motion for the flow. The results are presented via relevant tables and plots. Our findings show that a change in the position of the head causes variation in the external pressure, which in turn causes variation in the cross-sectional area of the vein. Moreover, a drop (or increase) in the inertial pressure of the blood may cause the vein to collapse (or distend), which again triggers a change in the pressure.