Document Detail

Is a Neutral Head Position as Effective as Head Rotation During Landmark-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial.
MedLine Citation:
PMID:  22995458     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn. DESIGN: A prospective, randomized, controlled study. SETTING: An education and research hospital and a university-affiliated hospital. PARTICIPANTS: Eighty patients requiring central venous catheterization in the right IJV. INTERVENTIONS: Under general anesthesia, patients were positioned in the Trendelenburg position with extension of the neck. In the rotated group, the head was rotated to the left at >45°. In the neutral group, the head was placed in the neutral position. Right IJV cannulation was performed using the central approach with the needle angled toward the ipsilateral nipple. The primary outcome variable was the cumulative success rate, which was defined as IJV puncture achieved in the first 3 attempts using a finder needle. A p value of <0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS: Groups were similar in terms of demographic data. The success rates of finder needle passes into the IJV on the first attempt were 87.5% and 37.5% (p < 0.05), and the cumulative success rates on the first 3 attempts were 97.5% and 57.5% in the rotated and neutral groups, respectively (p < 0.05). Carotid artery puncture only occurred in 2 patients in the rotated group. CONCLUSIONS: Because of the lower success rate, the neutral head position is not an attractive alternative for IJV catheterization when compared with the rotated head position in a central landmark IJV approach.
Burhan Apiliogullari; Inci Kara; Seza Apiliogullari; Oguzhan Arun; Ali Saltali; Jale Bengi Celik
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-18
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  -     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Thoracic Surgery, Konya Education and Research Hospital, Konya, Turkey. Electronic address:
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