Competence of the internal jugular vein valve is damaged by cannulation and catheterization of the interna. jugular vein

Background: Experimental results suggest that the competence of the interna l jugular vein (IJV) valve may be damaged when the IJV is cannulated for in sertion of a central venous catheter. It has further been hypothesized that the risk of causing incompetence of the proximally located valve might be reduced by using a more distal site for venous cannulation. The present stu dy evaluated these hypotheses in surgical patients. Methods: Ninety-one patients without preexising incompetence of the IJV val ve were randomly assigned to undergo distal or proximal IJV cannulation (gr eater than or equal to 1 cm above or below the cricoid level, respectively) . Color Doppler ultrasound was used to study whether new valvular incompete nce was present during Valsalva maneuvers after insertion of a central veno us catheter, immediately after removal of the catheter, and, in a subset of patients, several months after catheter removal, when compared with baseli ne findings before cannulation of the IJV. Results: Incompetence of the IJV valve was frequently induced both the prox imal and distal cannulation and catheterization of the IJV. Its incidence w as higher after proximal than after distal cannulation (76% vs. 41%; P < 0. 01) and tended to be so after removal of the catheter (47% vs. 28%; P = 0.0 7). Valvular incompetence persisting immediately after removal of the cathe ter did not recover within 8-27 months in most cases. Conclusions: Cannulation and catheterization of the IJV may cause persisten t incompetence of the IJV valve. Choosing a more distal site for venous can nulation may slightly lower the risk of causing valvular incompetence but d oes not reliably avoid it.