Citation Information :
Keshav M, Debele G, Bheemaiah R, Murthy K. Influence of Respiration on the Internal Jugular Vein Dimensions in Supine and Trendelenburg Positions. 2022; 1 (1):11-15.
Background: The standard practice for catheterization of needle-based interventions such as cannulation of the internal jugular vein (IJV) is performed by using the guidance of ultrasound (US) for vascular access during anesthetic care. Catheterization of IJV is the most common site for central venous access due to lower mechanical complications rates during insertion of a central venous catheter (CVC) compared to other routes such as subclavian vein. The purpose of this study was to determine the influence of respiration and position of the patient in awake and anesthetized conditions on the size of IJV.
Materials and methods: This study was a prospective cohort study conducted on cardiac surgical patients. The dimensions of the right IJV (RIJV) were measured during two phases of respiration (inspiration and expiration) using 2-dimensional (2D) US with the patient in supine and Trendelenburg positions in both awake and anesthetized mechanically ventilated states.
Results: It was found that the Trendelenburg position during spontaneous breathing was the most favorable state for IJV puncture as the anteroposterior (AP) as well as lateral diameters both increased significantly during inspiration, and the lateral diameter increased significantly during expiration. The Trendelenburg in a mechanically ventilated state resulted in an increase in the AP and lateral diameters during inspiration, but there was no change during expiration. There were no complications during the study.
Conclusion: The Trendelenburg position in awake spontaneously breathing patients is the most favorable state for performing IJV puncture.
Muralidhar K. Left internal versus right internal jugular vein access to central venous circulation using the Seldinger technique. J Cardiothorac Vasc Anesth 1995;9(1):115–116. DOI: 10.1016/s1053-0770(05)80084-9
Grebenik CR, Boyce A, Sinclair ME, et al. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004;92(6):827–830. DOI: 10.1093/bja/aeh134
Palepu GB, Deven J, Subrahmanyam M, et al. Impact of ultrasonography on central venous catheter insertion in intensive care. Indian J Radiol Imaging 2009;19(3):191–198. DOI: 10.4103/0971-3026.54877
Botero M, White SE, Younginer JG, et al. Effects of trendelenburg position and positive intrathoracic pressure on internal jugular vein cross-sectional area in anesthetized children. J Clin Anesth 2001;13(2):90–93. DOI: 10.1016/s0952-8180(01)00220-3
Lobato EB, Sulek CA, Moody RL, et al. Cross-sectional area of the right and left internal jugular veins. J Cardiothorac Vasc Anesth 1999;13(2):136–138. DOI: 10.1016/s1053-0770(99)90075-7
Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004;30(9):1740–1746. DOI: 10.1007/s00134-004-2259-8
Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 1993;87(5):1557–1562. DOI: 10.1161/01.cir.87.5.1557
Mallory DL, McGee WT, Shawker TH, et al. Ultrasound guidance improves the success rate of internal jugular cannulation. A prospective, randomized trial. Chest 1990;98(1):157–160. DOI: 10.1378/chest.98.1.157
Koski EM, Suhonen M, Mattila MA. Ultrasound-facilitated central venous cannulation. Crit Care Med 1992;20(3):424–426. DOI: 10.1097/00003246-199203000-00021
Mey U, Glasmacher A, Hahn C, et al. Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients. Support Care Cancer 2003;11(3):148–155. DOI: 10.1007/s00520-002-0399-3
Verghese ST, Nath A, Zenger D, et al. The effects of the simulated Valsalva maneuver, liver compression, and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children. Anesth Analg 2002;94(2):250–254. DOI: 10.1097/00000539-200202000-00004
Armstrong PJ, Sutherland R, Scott DH. The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 1994;38(3):229–231. DOI: 10.1111/j.1399-6576.1994.tb03879.x
Clenaghan S, McLaughlin RE, Martyn C, et al. Relationship between Trendelenburg tilt and internal jugular vein diameter. Emerg Med J 2005;22(12):867–868. DOI: 10.1136/emj.2004.019257
Lee SC, Han SS, Shin SY, et al. Relationship between positive end-expiratory pressure and internal jugular vein crosssectional area. Acta Anaesthesiol Scand 2012;56(7):840–845. DOI: 10.1111/j.1399-6576.2011.02638.x
Manikappa S, Cokis C. Assessment of internal diameter and cross-sectional area of right internal jugular vein pre-induction and postintubation. Anaesth Intensive Care 2005;33(3):381–383. DOI: 10.1177/0310057X0503300314
Lobato EB, Florete OG Jr, Paige GB, et al. Cross-sectional area and intravascular pressure of the right internal jugular vein during anesthesia: effects of Trendelenburg position, positive intrathoracic pressure, and hepatic compression. J Clin Anesth 1998;10(1):1–5. DOI: 10.1016/s0952-8180(97)00189-x