| The Examination of Internal Jugular Vein and Carotid Artery in Trendelenburg Position with Head Rotation; A Prospective, Randomized Study. |
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Ik Soo Chung, Min A Kwon, Hee Youn Hwang, Jeong Heon Park, Jin Seok Yeo, Chung Su Kim, Tae Soo Hahm, Sang Min Lee, Hyun Sung Cho |
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. minah.kwon@samsung.net
2Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea. |
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| Abstract |
BACKGROUND
This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography.
METHODS
Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15o trendelenburg position with 30o head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed.
RESULTS
At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30degrees was 1.82 cm.
CONCLUSIONS
In 18.5% of patients positioned in the 15o Trendelenburg position, with their head turned to the left 30degrees, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique. |
| Key Words:
carotid artery; catheterization; internal jugular vein; sternocleidomastoid muscle; ultrasonography |
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