Ultrasonographic Assessment of Anatomic Relationship Between the Internal Jugular Vein and the Common Carotid Artery in Infants and Children After ETT or LMA Insertion: A Prospective Observational Study

Abstract

Background: Central venous catheterization is used for fluid management and infusion of drugs, but it is difficult to perform and carries a high incidence of complications in infants and children. In adults, the anatomic relationship and the overlap index between the internal jugular vein (IJV) and the common carotid artery (CCA) changed significantly after laryngeal mask airway (LMA) placement. However, there are conflicting results regarding the anatomic relationship between the IJV and the CCA after endotracheal tube (ETT) or LMA insertion in pediatric populations.Aim: The aim of this study was to compare the overlap index and anatomic relationship between the IJV and the CCA in infants and children after ETT or LMA insertion by ultrasonography.Method: This single-center, prospective, observational study including 92 infants and children, aged 1 month to 6 years, were grouped according to the airway devices placed: Group ETT (n = 44) and Group LMA (n = 48). The overlap index and anatomic relationship between the IJV and the CCA before and after airway device insertion at neutral and 30 • head rotation position were evaluated by ultrasonography. was still the most common position relationship between the IJV and the CCA before and after intubation in the 30 • head rotated position. In Group LMA, the anterior (A) position increased significantly after LMA insertion in the left side. In the 30 • head rotated position, there was a significant increase to the A position after LMA insertion in both the right side and left side. The change from AL to A was increased after LMA insertion, especially in the 30 • head rotated position. Conclusions:The overlap indexes of the IJV and the CCA increased significantly in both sides of the neck after LMA placement in the neutral head position, especially in 30 • head rotated position. The IJVs after LMA placement had a tendency to become anterior to the CCA when the head of the patient rotated to the opposite direction in infants and children.

Anatomical review of internal jugular vein cannulation

“…Two studies on neonates found the lateral IJV as the most common position [81,124]. Two pediatric studies found the IJV to be anterolateral to the CCA when the head position was 30° contralateral rotation and neutral [40,99]. Another study on pediatrics found the majority of IJV to be anterolateral or anterior to CCA, with position changing after insertion of a laryngeal mask airway [84].…”

“…The dimensions and anatomical relationships alter through the normal aging process, differ between genders, and are influenced by pathologies such as increased body mass index (BMI) [40,44,70,74,75,81,99,106,123]. It is important to be aware of these possible changes in varying patient populations, especially in IJV cannulation.…”