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

Nayman, Alaaddin; Önal, Özkan; Apilioğulları, Seza; Özbek, Seda; Saltali, Ali; Çelik, Jale Bengi; Temízöz, Osman; Çelik, Gülperi

doi:10.3109/0886022x.2015.1073052

Cited by 4 publications

(7 citation statements)

References 30 publications

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“…3,4,8,15,16 Dr. Trendelenburg popularized a head-down tilt of 45°, which acquired relevance when blind catheterization technique was implemented, to reduce injury. [17][18][19][20] Although the inclination has been modified, as most hospital beds, stretchers, and surgical tables do not reach such angulation, which is also not feasible in clinical scenarios, studies have debated its use.…”

Section: Trendelenburg Position For Internal Jugular Vein Catheteriza...mentioning

confidence: 99%

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis

et al. 2021

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To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

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Section: Trendelenburg Position For Internal Jugular Vein Catheteriza...mentioning

confidence: 99%

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis

et al. 2021

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“…Due to the controversy behind TP and HR, many guidelines avoid specifying patient positioning (Frykholm et al, 2014; Lamperti et al, 2020; Lamperti, Bodenham, et al, 2012; Saugel et al, 2017; Vizcarra et al, 2014). Authors have reported the use of TP does not significantly increase the size of the IJV, or it can increase de risk of complications, therefore discouraging its use (Jo et al, 2013; Nassar et al, 2013; Nayman et al, 2015). Contrary to this, a recent meta‐analysis concluded any TP ≥5° increased the CSA and anterior–posterior diameter of the right IJV, and TP above 10° did not further benefit size, similar to our results.…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria are of a healthy young adult population. The physiological vascular response may vary in patients with added pathologies such as chronic‐degenerative diseases, obesity, age, shock, among others (Dincyurek et al, 2015; Kim et al, 2016; Nayman et al, 2015; Onal et al, 2015). Although stretchers with adjustable positions are found in most clinics and hospitals, they do not include tools to report the angulation, and therefore in a clinical setting, TP must be calculated visually by personnel performing the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria are of a healthy young adult population. The physiological vascular response may vary in patients with added pathologies such as chronicdegenerative diseases, obesity, age, shock, among others (Dincyurek et al, 2015;Kim et al, 2016;Nayman et al, 2015;Onal et al, 2015).…”

Section: Limitationsmentioning

confidence: 99%

“…The Trendelenburg position (TP), originally described at a 45° inclination, favors venous blood return to increase the veins' cross‐sectional area (CSA), although the position has been modified to make it feasible in current clinical scenarios, and many times this is referred to as head‐down tilt (Bellazzini et al, 2009; Bernstein et al, 1999; Bos et al, 2016; Marcus et al, 2010; Nayman et al, 2015). Contralateral HR does not exhibit changes on the CSA of the IJV and allows better exposure (Garcia‐Leal et al, 2021; Quiroga‐Garza et al, 2021; Suarez et al, 2002; Wang et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Trendelenburg (Head‐Down tilt) and head rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety

et al. 2022

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Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head‐down tilt (Trendelenburg position) and head rotation on the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross‐sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head‐rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5‐min rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78 cm2 with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59 cm2. A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA.

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The Effects of Positioning on the Volume/Location of the Internal Jugular Vein Using 2-Dimensional Tracked Ultrasound

Wang

Liao

Chen

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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

Cited by 4 publications

References 30 publications

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis

Trendelenburg (Head‐Down tilt) and head rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety

The Effects of Positioning on the Volume/Location of the Internal Jugular Vein Using 2-Dimensional Tracked Ultrasound

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