| Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter. | |
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MedLine Citation:
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PMID: 15064268 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The right internal jugular (RIJ) is commonly used to provide central venous access, and success of cannulation shows a positive correlation with the vein's diameter. The purpose of this study is to establish the patient position resulting in the largest RIJ diameter. METHOD: 2D ultrasound was used to measure RIJ diameter, in varying body positions, in 21 healthy volunteers. RESULTS: In the neutral position (table flat, head on the table in midline) the RIJ diameter was (mean +/- standard deviation) 9.2 +/- 2.18 mm. A small pillow under the head increased RIJ diameter (10.6 +/- 2.16 mm, P < 0.001). Trendelenburg tilt of 15 degrees increased RIJ diameter (12.1 +/- 2.34 mm, P < 0.001). In the Trendelenburg position (15 degrees of tilt), a small pillow under the head further increased RIJ diameter (13.3 +/- 2.26, mm P < 0.001), palpating for the carotid artery decreased RIJ diameter (8.2 +/- 1.98 mm, P < 0.001), and rotation of the head 45 degrees to the left did not reduce RIJ diameter significantly (11.7 +/- 2.52 mm, P = 0.12). CONCLUSION: The patient position to achieve maximal RIJ diameter cannulation is: 15 degrees of Trendelenburg tilt; a small pillow or head ring under the head; the head in or close to midline; and after palpation of the carotid artery, it should be released prior to vein cannulation. |
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Authors:
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Gareth Parry |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Canadian journal of anaesthesia = Journal canadien d'anesthésie Volume: 51 ISSN: 0832-610X ISO Abbreviation: Can J Anaesth Publication Date: 2004 Apr |
Date Detail:
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Created Date: 2004-04-05 Completed Date: 2004-10-07 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8701709 Medline TA: Can J Anaesth Country: Canada |
Other Details:
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Languages: eng Pagination: 379-81 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada. garethandantonia@ntlword.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Head
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physiology* Head-Down Tilt / physiology* Humans Jugular Veins / anatomy & histology*, ultrasonography Posture / physiology* Reference Values Vascular Patency / physiology* |
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