V.S. Eckle, B. Neumann, T.O. Greiner, H.P. Wendel, C. Grasshoff

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Intrajugular balloon catheter reduces air embolism in vitro and in vivo V.S. Eckle, B. Neumann, T.O. Greiner, H.P. Wendel, C. Grasshoff British Journal of Anaesthesia Volume 114, Issue 6, Pages 973-978 (June 2015) DOI: 10.1093/bja/aev040 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 The intrajugular balloon catheter is a 3-lumen central venous catheter, equipped with an additional lumen (2) for inflating a balloon cuff (3). The first orifice of the lumina is proximal (*), while the second and third orifices are medial (**) and distal (***), respectively. British Journal of Anaesthesia 2015 114, 973-978DOI: (10.1093/bja/aev040) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 (a) Artificial vessel containing water and air bubbles to simulate air embolism. (b) The intrajugular balloon catheter was inserted from the top of the artificial vessel. (c) The balloon of the intrajugular catheter was inflated. Note that the artificial vessel is completely obstructed. (d) Air accumulated under the inflated balloon. To improve clarity, the water in the artificial vessel was coloured with beetroot juice. British Journal of Anaesthesia 2015 114, 973-978DOI: (10.1093/bja/aev040) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 (a) View of an intrajugular balloon catheter (whitish) within a jugular vein. Note the venous blood flow determined by Doppler (blue). (b) After inflation of the balloon (dotted line), blood flow was completely obstructed. The catheter tip is marked by an asterisk (white). A typical air shadow of the inflate cuff is clearly visible. (c) After deflation of the cuff, venous blood flow returned. British Journal of Anaesthesia 2015 114, 973-978DOI: (10.1093/bja/aev040) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 Time course of the jugular venous pressure (JVP) before and after cuff inflation. Bilateral inflation of the cuffs (green bars) significantly increased the proximal JVP by 54 (12%) indicating obstruction (n=8, * indicates a significant difference (P<0.05) after a Bonferroni correction). Deflation of the balloon (off) returned JVP values to baseline (control). British Journal of Anaesthesia 2015 114, 973-978DOI: (10.1093/bja/aev040) Copyright © 2015 The Author(s) Terms and Conditions

Fig 5 (a) View of the intrajugular balloon catheter inserted in a jugular vessel in a representative animal. (b) Inflation of the balloon was clearly visible. (c) To mimic air embolism, air was injected slowly after cuff inflation. (d) After 30 s, an attempt was made to aspirate the remaining air through the proximal orifice of the catheter. British Journal of Anaesthesia 2015 114, 973-978DOI: (10.1093/bja/aev040) Copyright © 2015 The Author(s) Terms and Conditions