Cannulation of the right internal jugular vein for central venous pressure--a review.

Central venous pressure (CVP) monitor. ing is a useful tool in the anesthetic management of the seriously ill patient for both emergency and elective procedures. A working knowledge of anatomy, various techniques, and the proper indication for CVP must be foremost in the anesthetist's mind. There are a number of techniques used in the placement of the CVP catheter. The purpose of this article is to review these areas, with emphasis on placement in the internal jugular vein (IJV), elaborating on technique, advantages and disadvantages. The indications for the insertion and monitoring of the central venous pressure (CVP) are as follows: (1) patients undergoing surgery in which a major volume shift may occur (such as in the Whipple procedure) ; (2) operations where the potential for hypovolemia exists (such as in a bowel resection); (3) patients in shock (such as in trauma) ; (4) operations performed with the patient in the sitting position with risk of air embolization; and (5) some selected patients with congestive heart failure. A Swan-Ganz catheter rather than a CVP catheter probably would be placed for assessment of left heart filling pressures in patients with severe left ventricular dysfunction.