Valves in internal jugular vein: A reason of difficult central venous catheterization

A three-way central venous catheter (CVC) was inserted for a 57-year-old liver-transplant patient through his left internal jugular vein (IJV) with Seldinger technique. Small resistance was encountered when a guidewire was inserted at 15cm. We removed the guidewire and draw the blood from the syringe to make sure the needle tip is still in the vessel. We re-inserted the guidewire again, but resistance was also found again. Since the guidewire didn't meet any resistance until 15cm, we slightly withdraw the guide wire and insert the CVC into the vein at 12cm without difficulty.
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research