Document Detail

Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter.
MedLine Citation:
PMID:  15064268     Owner:  NLM     Status:  MEDLINE    
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.
Gareth Parry
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2004-04-05     Completed Date:  2004-10-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  379-81     Citation Subset:  IM    
Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada.
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MeSH Terms
Head / physiology*
Head-Down Tilt / physiology*
Jugular Veins / anatomy & histology*,  ultrasonography
Posture / physiology*
Reference Values
Vascular Patency / physiology*

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