Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study

Abstract

Purpose: The aim of this study is to determine the optimal angle of needle entry in the sagittal plane for internal jugular vein (IJV) catheterization with the central approach while the head is in the neutral position. Methods: The contrast-enhanced carotid artery computed tomography angiographies of 123 consecutive patients were retrospectively reviewed. The point of merger between the sternal and clavicular heads of the sternocleidomastoid muscle was assumed as a clinical entry (CE) point. The angle between CE point and the center of the IJV, the depth, diameter of the vessels and the degree of overlap between the IJV and carotid artery (CA) were measured. Results: The angles between the CE point and the center of the IJVs were similar, 7°± 13°medial and 8°± 12°medial on the right and the left side, respectively. The center of IJVs from the CE point was between 0°and 16°toward the medial in 79.8% on the right side and 89.9% on the left side of patients. The diameters of the right IJVs were greater than the left IJVs (p = 0.001). The depth from the skin and overlap between IJV and CA did not vary between the two sides. Conclusions: When a central approach is used for right internal jugular vein (RIJV) cannulation with a neutral head position, the orientation of the angle of needle entry (i.e., 16°) medially in the sagittal plane may quadruple the success rate of RIJV catheterization compared to the success rate of a laterally oriented angle of entry as recommended by the classic method.

Simple manoeuvre to reduce the overlap between the internal jugular vein and carotid artery in infants

“…However, the IJV catheterisation in neutral head position is sometimes impossible in infants because of the big head and the relatively short neck. Moreover, the location of the IJV in neutral head position would be different compared with applying the head rotation to the contralateral side, in anatomical landmark and the needle entry points . Furthermore, the success rate in the neutral head position was significantly lower than that in the 45° head rotation (57.5% vs. 97.5%) .…”

Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation

“…Head rotation can increase the visibility of anatomical landmarks, thus facilitating skin puncture and cannulation. 3,12,18 However, Lamperti et al 12 reported that the perception of difficulty in patients in the neutral and head turned positions during IJV cannulation did not significantly differ among the anesthesiologists (9% in the neutral position vs. 11% in the head turned position) when performed under ultrasound guidance.…”

“…It is important to avoid CA puncture during the IJV cannulation in dialysis patients, 18 which can occur even when performed under ultrasound guidance. Head rotation can increase the visibility of anatomical landmarks, thus facilitating skin puncture and cannulation.…”

“…Routine hemodynamic monitoring was carried out during the operation. The patient was positioned in the [15][16][17][18][19][20] Trendelenburg position with neck extension without a pillow. Before the administration of anesthesia, the RIJV and CA were ultrasonographically measured using a LOGIQ Book XP (GE Healthcare, Wauwatosa, WI) with a linear (7.5 MHz) probe.…”

Avoiding Complications During Insertion

“…In a review of 123 consecutive patients who had a CT, the right internal jugular (RIJ) had an average diameter of 15.6 mm versus 11.7 left internal jugular, the overlap with the carotid artery was not significantly different comparing right to left, and depth of the skin to vein was also similar (Ozbek et al 2013). The authors also examine the incidence of veins less than 7 mm, which was 4.4% for RIJs and 21.9% for left internal jugular veins.…”