Unintended Intrathecal Cannulation during Internal Jugular Venipuncture : A Possible Mechanism

Unintended intrathecal cannulation is a dangerous complication of internal jugular venipuncture which has been reported in both pediatric and adult patients using both the anatomic landmark and ultrasound-guided techniques. Many possible causes have been considered in the literature, but there is no consensus about the actual mechanism. We hypothesize the importance of three factors in the occurrence of this complication, including : 1) rotating the head excessively to the contralateral side, 2) directing the needle medially, and 3) deep insertion of the needle. These three factors are based on the anatomy of the neck and central veins. The mechanism of this complication in previous reports may be explained by some combination of these factors. This hypothesis may serve as a challenge to prevent this rare but serious complication.