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Internal Jugular Thrombosis and Pulmonary Embolism

1981; Elsevier BV; Volume: 80; Issue: 3 Linguagem: Inglês

10.1378/chest.80.3.335b

1931-3543

William R. Bradway, Robert J. Biondi, Jeffrey L. Kaufman, James C. Giudice,

Venous Thromboembolism Diagnosis and Management

To the Editor:Venous thrombosis is considered an uncommon complication of indwelling central venous catheters.1Jernigan WR Gardner WC Mahr MM et al.Use of the internal jugular vein for placement of central venous catheter.Surg Gynec Obstet. 1970; 130: 520-524PubMed Google Scholar, 2Johnson FE Internal jugular vein catheterization.N Y State J Med. 1978; : 2168-2171Google Scholar, 3Benotti PN Bothe A Miller JD et al.Safe cannulation of the internal jugular vein for long term hyperalimentation.Surg Gynec Obstet. 1977; 144: 574-576PubMed Google Scholar Pulmonary embolism and right internal jugular thrombosis at the site of an indwelling Cordis sheath introducer was noticed at a recent autopsy. Venous thrombosis was not found elsewhere, although careful examination of the femoral, pelvic, great venous structures and the heart was performed. This case prompted a review of all autopsies performed from December, 1979, through July, 1980, at our institution. *John F. Kennedy Memorial Hospital, Stratford Division *John F. Kennedy Memorial Hospital, Stratford DivisionFifty autopsies were performed during this time. Twenty-six had indwelling internal jugular Cordis sheath introducers at some time during the hospital course. Four of the 26 cases had ipsilateral gross internal jugular thrombi at the site of the Cordis sheath, and two of these four cases had significant pulmonary emboli (venous thrombosis elsewhere was not identified).Three of the four cases with internal jugular thrombosis (Cordis site) also had Swan-Ganz pulmonary artery catheters placed through the internal jugular Cordis sheath introducer at one time during their hospital course. One of the three cases had both internal jugular thrombosis and pulmonary emboli at autopsy.At our hospital, Cordis sheath introducers routinely have been placed within an internal jugular vein to establish a route for subsequent Swan-Ganz catheter or temporary cardiac pacemaker catheter placement. This procedure is routinely performed by a member of the medical resident staff, trained in the technique, and is done aseptically at the bedside. Swan-Ganz catheters and cardiac pacemakers are usually removed within three days. Indwelling Cordis sheath introducers are often maintained for longer periods with the administration of crystaloid through the infusion arm of the Cordis sheath introducer. In this series, the duration of all Cordis sheath introducers ranged from 4½ hours to 10 days, with the mean duration of 4½ days. Local cellulitis of the sheath site was not evident from hospital records or autopsy. Daily maintenance by the nursing staff with aseptic techniques is adhered to strictly at our institution.This report emphasizes the fact that venous thrombosis, as well as pulmonary thromboembolism, may represent significant hazards of internal jugular venous catheterization. This has not been reported or emphasized previously. Conversely, Turnbull et al4Turnbull AD Carlon G Makowsky M et al.Multipurpose central venous access using the Cordis sheath introducer system.Crit Care Med. 1979; 7: 30-32Crossref PubMed Scopus (7) Google Scholar reported no thromboembolic complications of internal jugular catheterization with the Cordis sheath introducer in 175 patients. Potential mechanisms for the development of internal jugular venous thrombosis in the autopsy series reported include: 1) the known thrombogenic features of the Swan-Ganz catheter;5Hoar PF Stone JG Wilks AE et al.Thrombogenesis associated with Swan-Ganz catheters.Anesthesiology. 1978; 48: 445-447Crossref PubMed Scopus (49) Google Scholar, 6Dye LE Segall PH Russell RD et al.Deep venous thrombosis of the upper extremity associated with use of the Swan-Ganz catheter.Chest. 1979; 73: 673-675Abstract Full Text Full Text PDF Scopus (42) Google Scholar 2) potential thrombogenic influence of the Cordis catheter; 3) possible potentiation of 1 and 2.In conclusion, we wish to emphasize the fact that internal jugular thrombosis can occur in critically ill patients, is often unrecognized, and can result in life-threatening pulmonary emboli. To the Editor: Venous thrombosis is considered an uncommon complication of indwelling central venous catheters.1Jernigan WR Gardner WC Mahr MM et al.Use of the internal jugular vein for placement of central venous catheter.Surg Gynec Obstet. 1970; 130: 520-524PubMed Google Scholar, 2Johnson FE Internal jugular vein catheterization.N Y State J Med. 1978; : 2168-2171Google Scholar, 3Benotti PN Bothe A Miller JD et al.Safe cannulation of the internal jugular vein for long term hyperalimentation.Surg Gynec Obstet. 1977; 144: 574-576PubMed Google Scholar Pulmonary embolism and right internal jugular thrombosis at the site of an indwelling Cordis sheath introducer was noticed at a recent autopsy. Venous thrombosis was not found elsewhere, although careful examination of the femoral, pelvic, great venous structures and the heart was performed. This case prompted a review of all autopsies performed from December, 1979, through July, 1980, at our institution. *John F. Kennedy Memorial Hospital, Stratford Division *John F. Kennedy Memorial Hospital, Stratford Division Fifty autopsies were performed during this time. Twenty-six had indwelling internal jugular Cordis sheath introducers at some time during the hospital course. Four of the 26 cases had ipsilateral gross internal jugular thrombi at the site of the Cordis sheath, and two of these four cases had significant pulmonary emboli (venous thrombosis elsewhere was not identified). Three of the four cases with internal jugular thrombosis (Cordis site) also had Swan-Ganz pulmonary artery catheters placed through the internal jugular Cordis sheath introducer at one time during their hospital course. One of the three cases had both internal jugular thrombosis and pulmonary emboli at autopsy. At our hospital, Cordis sheath introducers routinely have been placed within an internal jugular vein to establish a route for subsequent Swan-Ganz catheter or temporary cardiac pacemaker catheter placement. This procedure is routinely performed by a member of the medical resident staff, trained in the technique, and is done aseptically at the bedside. Swan-Ganz catheters and cardiac pacemakers are usually removed within three days. Indwelling Cordis sheath introducers are often maintained for longer periods with the administration of crystaloid through the infusion arm of the Cordis sheath introducer. In this series, the duration of all Cordis sheath introducers ranged from 4½ hours to 10 days, with the mean duration of 4½ days. Local cellulitis of the sheath site was not evident from hospital records or autopsy. Daily maintenance by the nursing staff with aseptic techniques is adhered to strictly at our institution. This report emphasizes the fact that venous thrombosis, as well as pulmonary thromboembolism, may represent significant hazards of internal jugular venous catheterization. This has not been reported or emphasized previously. Conversely, Turnbull et al4Turnbull AD Carlon G Makowsky M et al.Multipurpose central venous access using the Cordis sheath introducer system.Crit Care Med. 1979; 7: 30-32Crossref PubMed Scopus (7) Google Scholar reported no thromboembolic complications of internal jugular catheterization with the Cordis sheath introducer in 175 patients. Potential mechanisms for the development of internal jugular venous thrombosis in the autopsy series reported include: 1) the known thrombogenic features of the Swan-Ganz catheter;5Hoar PF Stone JG Wilks AE et al.Thrombogenesis associated with Swan-Ganz catheters.Anesthesiology. 1978; 48: 445-447Crossref PubMed Scopus (49) Google Scholar, 6Dye LE Segall PH Russell RD et al.Deep venous thrombosis of the upper extremity associated with use of the Swan-Ganz catheter.Chest. 1979; 73: 673-675Abstract Full Text Full Text PDF Scopus (42) Google Scholar 2) potential thrombogenic influence of the Cordis catheter; 3) possible potentiation of 1 and 2. In conclusion, we wish to emphasize the fact that internal jugular thrombosis can occur in critically ill patients, is often unrecognized, and can result in life-threatening pulmonary emboli. An Unusual Mechanism for a Fistulous Communication between the Aorta and the Right Side of the HeartCHESTVol. 80Issue 3PreviewTo the Editor: Full-Text PDF