Factors Predictive of Right Internal Jugular Vein Cross-Sectional Area Change in Response to Trendelenburg Positioning

Abstract

Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.

Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients

“…All of the patients were positioned with their neck in extension and head rotated left at [20][21][22][23][24][25][26][27][28][29][30] . Patients were studied in State 0, table flat (no tilt), with the patients in the supine position, and State T, in which the operating table was tilted 15 to a TP.…”

“…Similar findings were reported in another study conducted by Modeliar et al 24 who found that the TP increased the mean CSA by only 15% in 60 ICU patients. Maratea et al 28 evaluated the extent of change of the CSA of the right IJV in response to TP in anesthetized patients and its predictive factors. They showed that right IJV dilation in response to TP was only significantly different in male patients.…”

“…10 Therefore, excessive left rotation should be avoided to minimize the risk of unintentional CA puncture during right IJV cannulation. In the present study, each patient's head was positioned with the head rotated left at [20][21][22][23][24][25][26][27][28][29][30] . According to our review of the literature, the effects of TP on the overlap between the CA and the IJV have not yet been evaluated.…”