UNASSIGNED: Prompt assessments and quick replacement of intravascular fluid are critical steps to resuscitate hypovolemic patients. Intravascular volume assessment by direct central venous pressure (CVP) measurement is an invasive, time-consuming, and labor-intensive procedure. Nowadays, bedside ultrasound-guided volume assessment of the internal jugular vein (IJV) or inferior vena cava (IVC) is commonly employed as a proxy for direct CVP.Therefore, we examined the strength of association between CVP and collapsibility index (CI) of the IJV and IVC for evaluating the volume status of critically ill patients.
UNASSIGNED: Bedside USG-guided A-P diameter and cross-sectional area of the right IJV and IVC were measured, and their corresponding collapsibility indices were deduced. The results of the IJV and IVC indices were correlated with CVP.
UNASSIGNED: About 60 out of 70 enrolled patients were analyzed. The baseline clinical parameters of patients are shown in Table 1. For CSA and AP diameter, the correlations between CVP and IJV-CI at 0° were r = -0.107 (p = 0.001) and r = -0.092 (p = 0.001). Correlations between CVP and IJV-CI at 30° for CSA and diameter, however, were (r = -0.109, p = 0.001) and (r = -0.117, p = 0.001), respectively. Table 2 depicts the correlation between CVP and IVC-CI r = -0.503, p = 0.001 for CSA and r = -0.452, p = 0.001 for diameter.
UNASSIGNED: The IVC and IJV collapsibility indices can be used in place of invasive CVP monitoring to assess fluid status in critically ill patients.
UNASSIGNED: Kumar A, Bharti AK, Hussain M, Kumar S, Kumar A. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study. Indian J Crit Care Med 2024;28(6):595-600.

Neurofibromatosis Type 1 (NF1) is a rare autosomal dominant disorder that has a wide array of clinical manifestations. NF1 Vasculopathies constitute 0.4% to 6.4% of the findings and they often develop in the arterial circulation while venous involvement is rare. We present a case of a 73-year-old male with NF1 with an incidental finding of right neck swelling for 2 months. Different radiological modalities were performed, identifying the lesion as an internal jugular vein aneurysm. The patient was managed conservatively as he was asymptomatic in relation to the swelling. NF1 venous vasculopathies are rare but they have detrimental consequences such as rupture and severe hemorrhage in view of the fragility of the aneurysmal wall and the infiltration of the neurofibroma into the vessel. Hence, high clinical suspicion and selective imaging and follow-up is advisable for physicians.

Central venous pressure (CVP) serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume, venous compliance, cardiac output, and orthostasis. Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance. Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances. Elevated CVP can lead to fluid accumulation in the interstitial space, impairing venous return and reducing cardiac preload. While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate, they carry risk of complications and their usage has not shown clinical improvement. Ultrasound-based assessment of the internal jugular vein (IJV) offers real-time, non-invasive measurement of static and dynamic parameters for estimating CVP. IJV parameters, including diameter and ratio, has demonstrated good correlation with CVP. Despite significant advancements in non-invasive CVP measurement, a reliable tool is yet to be found. Present methods can offer reasonable guidance in assessing CVP, provided their limitations are acknowledged.

This paper reports a case of an internal jugular venous malformation (IJVM) and route of treatment in a patient with limited symptoms. After history and imaging studies, a determination of surgical excision was made to rule out possible malignancy and future problems such as thrombosis. The mass was resected, and part of the IJVM was ligated. The mass had no identifiable malignancy, and the patient recovered fully with no complications. The paper highlights the importance of identifying venous malformations and highlights the reasoning behind the course of action.

We analyzed chemoport insertion procedures to evaluate infectious morbidity and factors causing infection. This single-center retrospective study included 1690 cases of chemoport implantation between January 2017 and December 2020. Overall, chemoports were inserted in 1582 patients. The average duration of chemoport use was 481 days (range 1-1794, median 309). Infections occurred in 80 cases (4.7%), with 0.098 per 1000 catheter-days. Among the 80 cases in which chemoports were removed because of suspected infection, bacteria were identified in 48 (60%). Significantly more cases of left internal jugular vein punctures were noted in the infected group (15 [18.8%] vs. 147 [9.1%]; p = 0.004). Pulmonary embolism was significantly different between the infection groups (3 [3.8%] vs. 19 (1.2%), p = 0.048). The hazard ratio was 2.259 (95% confidence interval [CI] 1.288-3.962) for the left internal jugular vein, 3.393 (95% CI 1.069-10.765) for pulmonary embolism, and 0.488 (95% CI 0.244-0.977) for chronic obstructive pulmonary disease. Using the right internal jugular vein rather than the left internal jugular vein when performing chemoport insertion might reduce subsequent infections.

The preservation of the spinal accessory nerve represents a key goal in head and neck oncologic surgery during selective neck dissection. This study aims to illustrate the anatomical variants of the XI cranial nerve, delving into the relationship between the spinal nerve and the internal jugular vein, as well as the surgical implications. Two cases of patients who underwent oncologic surgery with neck dissection are described. Both cases found the spinal accessory nerve passing through the fenestration of the internal jugular vein. Alongside this case series, an independent literature review was conducted using the Medline and PubMed databases. In the majority of cases (67% - 96%), the spinal accessory nerve traces a lateral course to the internal jugular vein. Less frequently, the XI cranial nerve courses medial to the internal jugular vein. More rarely, as described in this case series, the nerve crosses through the fenestration of the vein (0.48% - 3.3%).

Usually, the external jugular vein (EJV) is located superficially over the sternocleidomastoid muscle and joins the subclavian vein or the venous angle. The internal jugular vein (IJV) lies deeply in close relation with the common carotid artery and vagus nerve, enveloped by the carotid sheath. Normally, there is no direct connection between those vessels. During a routine neck dissection, we found a rare anastomosis between IJV and EJV. The anastomosis was localized on the level of the cricoid cartilage. It was approximately 1 cm long, with the diameter of the lumen being 0.3 cm. There was no obstruction along the length of the vessel. The direction was oblique and followed the blood flow from IJV to EJV. The observed variation has high clinical importance related to numerous procedures executed in the neck region, such as placement of hemodialysis catheter in patients with renal failure, insertion of central venous line in the care of critically ill patients, and radical neck dissections.

Point-of-care ultrasound (POCUS) of the internal jugular vein (IJV) offers a non-invasive means of estimating right atrial pressure (RAP), especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery. While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein, this method lacks sensitivity. The utilization of POCUS significantly enhances the visualization of the vein, leading to a more accurate identification. It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation. This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein, drawing upon existing data.

BACKGROUND: Ventricular shunts are one of the most frequent techniques used for the management of hydrocephalus. The ventriculoperitoneal shunt (VPS) is the most commonly performed procedure, and the ventriculoatrial shunt (VAS) is the second option in most medical centers. The main objective of this study is to introduce and describe a surgical approach for VAS outlining our experience and comparing it with traditional shunting techniques.
METHODS: In this retrospective cohort comparison study, we included patients with hydrocephalus treated with a surgical procedure between January 2010 and February 2021 at a single academic institution. We categorized the procedures into two groups: patients with VPS and conventional VAS grouped together into the conventional technique (CT) group, and the second group was patients with whom we performed VAS with complete internal jugular vein occlusion (IJVOT). We compared the surgical time, postoperative complications, and occurrence of shunt failure among the groups by performing univariate analysis using the Fisher exact test.
RESULTS: Out of the 106 patients included in the analysis, IJVOT was performed in 66 patients, and CT in 40 patients. The median surgical time was 60 min (IQR 60-90) for IJVOT versus 100 min (IQR 60-120) for CT (p < 0.01). In the follow-up a month after the procedure, 83.3% of patients with IJVOT and 62.5% of patients with CT did not require shunt removal or shunt revision (p < 0.01). Shunt revision rates were 12.5% and 1.5% for CT while 1.5% and 2.5% for IJVOT at 1 and 6 months after the procedure.
CONCLUSIONS: Our findings demonstrate that VAS with IJVOT is a safe method that exhibited shorter surgical times and outcomes comparable to CT. However, since the present study represents the first cohort evaluating IJVOT, it is imperative to conduct larger prospective studies, along with clinical trials, to fully explore and establish efficacy, long-term outcomes, and an in-depth comparison among shunting techniques.

UNASSIGNED: There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques.
UNASSIGNED: We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study\'s potential risk for bias.
UNASSIGNED: In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94-1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups.
UNASSIGNED: This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.