Assessment of head and neck position for optimal ultrasonographic visualisation of the internal jugular vein and its relation to the common carotid artery: A prospective observational study.
Common carotid artery
Trendelenburg
internal jugular vein
ultrasonography
Journal
Journal of anaesthesiology, clinical pharmacology
ISSN: 0970-9185
Titre abrégé: J Anaesthesiol Clin Pharmacol
Pays: India
ID NLM: 9516972
Informations de publication
Date de publication:
Historique:
received:
24
10
2018
revised:
06
03
2019
accepted:
29
03
2019
entrez:
17
3
2020
pubmed:
17
3
2020
medline:
17
3
2020
Statut:
ppublish
Résumé
There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship. A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°. Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left, There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship.
MATERIAL AND METHODS
METHODS
A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°.
RESULTS
RESULTS
Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left,
CONCLUSION
CONCLUSIONS
There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.
Identifiants
pubmed: 32174660
doi: 10.4103/joacp.JOACP_330_18
pii: JOACP-36-62
pmc: PMC7047683
doi:
Types de publication
Journal Article
Langues
eng
Pagination
62-65Informations de copyright
Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
Crit Care Med. 1991 Dec;19(12):1516-9
pubmed: 1959371
Middle East J Anaesthesiol. 2008 Oct;19(6):1305-20
pubmed: 18942245
Anesth Analg. 1996 Jan;82(1):125-8
pubmed: 8712386
Anesthesiology. 1996 Jul;85(1):43-8
pubmed: 8694381
Eur J Anaesthesiol. 2011 May;28(5):351-5
pubmed: 21150630
J Am Soc Echocardiogr. 2011 Dec;24(12):1291-318
pubmed: 22115322
Anesth Analg. 1991 Jun;72(6):823-6
pubmed: 2035868