J Thorac Cardiovasc Surg 1995;109:391-393
© 1995 Mosby, Inc.
A simplified technique for selective jugular vein cannulation
Akio Matsuura, MD,
Masaru Sawasaki, MD,
Kenzo Yasuura, MD,
Takashi Maseki, MD,
Toshihiko Ichihara, MD,
Toshiaki Ito, MD,
Ken Miyahara, MD,
Hiroshi Okamoto, MD,
Toshio Abe, MD
Nagoya, Japan
From the Department of Thoracic Surgery, Nagoya University School of Medicine, Tsurumaichou-65, Shouwa-ku, Nagoya, Japan.
Hypothermic retrograde cerebral perfusion has been a successful method of cerebral protection during aortic arch operations 
1 This perfusion has generally been accomplished via a cannula in the superior vena cava. However, in some cases valves at the venous angle (jugular-subclavian junction) may not allow retrograde flow to the brain. 2,3 One solution is to selectively place the cannula in the internal jugular vein above the venous angle to assure adequate cerebral perfusion. 4 We report a simple technique for selective internal jugular vein cannulation using a central venous catheter and a dissector for the microsurgical operation (Fig. 1).
After induction of anesthesia, a central venous catheter is percutaneously inserted into the right atrium via the right internal jugular vein. After thoracotomy, a pursestring suture is placed in the superior vena cava and a venotomy is made. The tip of the central venous catheter is pulled through the incision with a curved dissector (Fig. 2, A). A soft-tipped venous cannula (28F) is modified by cutting its tip so that it fits over the shaft of an Endo Dissect device (United States Surgical Corp., Norwalk, Conn.). The end of the central venous catheter is grasped by the jaws of the Endo Dissect device and the modified venous cannula is advanced over it (Fig. 2, B). Grasping the catheter with the Endo Dissect device prevents coiling, and the venous cannula can be easily slid into the internal jugular vein beyond the venous valves (Fig. 2, C). The Endo Dissect device is withdrawn, and the cannula is connected to the extracorporeal circuit. The cannula is used for venous drainage during conventional cardiopulmonary bypass and switched to the arterial return circuit during retrograde cerebral perfusion.
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Fig. 2. Technique of selective internal jugular vein cannulation. SVC, Superior vena cava; RA, right atrium; IJV, internal jugular vein; SCV, subclavian vein.
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We 4 have previously described a technique for selective internal jugular vein cannulation through a right atriotomy for which a central venous catheter and guidewire are used. A drawback in the previous technique is the need for assistance of an anesthesiologist to exchange venous catheters. The new method has several advantages over the previous method: The procedure can be performed entirely within the operative field without any assistance; the cannula is inserted directly through the superior vena cava without the need for atriotomy; and it can be used for both venous drainage and arterial return without exchange. We have used this technique successfully in seven patients undergoing aortic arch operations. Because it is a simple technique that allows for rapid and reliable internal jugular vein cannulation, we recommend its use.
Footnotes
J THORAC CARDIOVASC SURG 1995;109:391-3 
References
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Okamoto H, Sato K, Matsuura A, et al. Selective jugular cannulation for safer retrograde cerebral perfusion. Ann Thorac Surg 1993;55:538-40.[Abstract]
