[Optimizing puncture of the internal jugular vein. Effects and advantages of the Valsalva maneuver in catheterization].
Shortly after the publication by English et al. on catheterization of the internal jugular vein (VJI) in 1969, the first papers reporting complications appeared. To reduce the rate of puncture failures with their consequences and complications, we tried to find the optimal conditions for successful puncture by evaluating serial CT scans. The diameter increase of the VJI was studied in 8 women and 9 men with an average age of about 39 years with 30 mmHg pressure in the upper respiratory passages. The measurement was performed 2 cm below the level of the cricoid cartilage (the probable puncture point for posterior access). It was carried out first during normal respiration, then after forced inspiration and bearing down with the glottis open against a closed system consisting of a manometer. By means of continuous bearing down, a pressure of 30 mmHg was maintained during CT scanning. With this pressure in the upper respiratory passages, the mean increase in diameter of the VJI was 58% on the left side (P less than 0.002) and as much as 78% on the right (P less than 0.001), which is highly significant. In 12 of the 17 test persons (70.6%), the right VJI proved to be the dominant vessel, and the diameter increase achievable by the Valsalva maneuver likewise seems to be greater on the right side than on the left (Table 1). We now recommend a slight Trendelenburg position with the head rotated 45 degrees to the contralateral side. For the first puncture we consider the posterior approach (see Fig. 2) on the right side to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)