THE EFFECT OF RIGHT INTERNAL JUGULAR-VEIN CANNULATION ON INTRACRANIAL-PRESSURE

Access to the central venous circulation is often necessary in patient s who have elevated intracranial pressure. It has been suggested that a disadvantage of the internal jugular vein approach to the central ci rculation may be an elevated intracranial pressure. The purpose of thi s prospective study was to evaluate the effect of right internal jugul ar vein cannulation on intracranial pressure in patients who are at ri sk of intracerebral hypertension. Eleven adult patients studied in the intensive care unit were evaluated. The population included those pat ients who were admitted to the neurosurgical intensive care unit requi ring intracranial pressure monitoring and central venous access. With the intracranial pressure monitor in place, patients were put in supin e and 30 degrees head-up positions while intracranial pressure was rec orded. The Queckenstedt maneuver was performed on all patients. A cent ral venous line was then placed in the right internal jugular vein, an d intracranial pressure was recorded. The Queckenstedt maneuver was ag ain performed in the study population, and intracranial pressure measu rements were recorded for the right, left, and bilateral compression o f the internal jugular vein. The results of the intracranial pressure measurements before acid after placement of the central venous line we re statistically analyzed using single-factor analysis of variance ove r time. The mean Glasgow coma and Apache II scores for the study group s were 8 +/- 4 and 15 +/- 6, respectively. There were no significant d ifferences in heart rate; cerebral perfusion pressure; or systolic, me an, or diastolic pressures throughout the study period. There was no s tatistical difference found between the intracranial pressures at any time point throughout the study. Furthermore, no difference was found in percentage change from baseline intracranial pressure data througho ut the study period. Our results suggest that cannulation of the right internal jugular vein is a safe approach to the central circulation i n patients at risk of intracranial hypertension. A description of the possible accommodating mechanisms are outlined.