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.
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