Traumatic internal jugular vein cannulation.

Abstract

A 63-year-old man with acute myocardial infarction complicated by atrioventricular block underwent an insertion of a temporary electrode for cardiac pacing. The posterior approach for right internal jugular vein cannulation was used. A 15-gauge needle was inserted under the sternocleidomastoid muscle aiming at the suprasternal notch with a 30-degree posterior angle of entry. An hour later the patient started to hiccup. The hiccups were resistant to drug therapy and to cessation of pacing. A chest radiograph revealed elevation of the right diaphragm and hematoma on the right side of the trachea, possibly compressing the right phrenic nerve on its route beneath the sternocleidomastoid muscle and the internal jugular vein. Within seven days the hiccups gradually ceased. Our case shows the advantages and complications of internal jugular vein cannulation.