Comparison of the effect of the right lateral tilt position and Trendelenburg position on the right internal jugular vein in healthy volunteers: A prospective observational study

Abstract

Background:

Central venous cannulation is an invasive procedure commonly used by many physicians. The aim of this study was to evaluate the effects of the right lateral tilt position on the cross-sectional area and size of the right internal jugular vein, and the relationship between the right internal jugular vein and the carotid artery.

Method:

Forty healthy volunteers aged over 18 years were included in this prospective, observational study. The right internal jugular vein cross-sectional area and the anatomic relationship with the carotid artery were assessed using ultrasound imaging. This measurement was repeated for four positions (baseline position, 10° right tilt position, 10° Trendelenburg position, and 10° right tilt + 10° Trendelenburg position). The head was rotated 30° to the contralateral side in all patients.

Results:

The mean (standard deviation) right internal jugular vein cross-sectional area, transverse diameter, and anteroposterior diameter were significantly increased with the Trendelenburg position and 10° right tilt + 10° Trendelenburg position (p < 0.05). There were no significant differences in right internal jugular vein cross-sectional area, transverse diameter, and anteroposterior diameter between the baseline position and 10° right tilt position (p > 0.05).

Conclusion:

We found that the right lateral tilt position had no effect on the internal jugular vein cross-sectional area and that the Trendelenburg position was still the most valid position for safely increasing the right internal jugular vein cross-sectional area.

Keywords

Internal jugular vein right tilt position Trendelenburg position

Get full access to this article

View all access options for this article.

References

National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. Technology Appraisal Guidance No. 49, September 2002. London, www.nice.org.uk/pdf/ultrasound_49_GUIDANCE.pdf (accessed 20 September 2005).

Karaaslan

Gokay

Karakaya

, et al. Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter. Ann Saudi Med 2017; 37(4): 308–312.

Gordon

Saliken

Johns

, et al. US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 1998; 9(2): 333–338.

Lee

Park

Shin

, et al. Effect of Trendelenburg position on right and left internal jugular vein cross-sectional area. Korean J Anesthesiol 2014; 67(5): 305–309.

Gok

Sarkilar

Kilicaslan

, et al. Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients. Int J Clin Exp Med 2015; 8(10): 19037–19043.

Yuki

Chilson

Odegard

, et al. Trendelenburg position, simulated Valsalva maneuver, and liver compression do not alter the size of the right internal jugular vein in patients with a bidirectional Glenn shunt. Anesth Analg 2007; 105(2): 365–368.

Parry

Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter. Can J Anaesth 2004; 51(4): 379–381.

Marcus

Bonkat

Dagtekin

, et al. The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area. Anesth Analg 2010; 111(2): 432–436.

Lamperti

Subert

Cortellazzi

, et al. Is a neutral head position safer than 45-degree neck rotation during ultrasound-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial. Anesth Analg 2012; 114(4): 777–784.

10.

Furukawa

Fukuda

Takahashi

, et al. Effect of airway pressure and Trendelenburg position on the cross-sectional area of the internal jugular vein in anesthetized patients. Masui 2004; 53(6): 654–658.

11.

Clenaghan

McLaughlin

Martyn

, et al. Relationship between Trendelenburg tilt and internal jugular vein diameter. Emerg Med J 2005; 22(12): 867–868.

12.

Kim

Lim

, et al. The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults. Anaesth Intensive Care 2008; 36(1): 65–68.

13.

Wang

Snoey

Clements

, et al. Effect of head rotation on vascular anatomy of the neck: an ultrasound study. J Emerg Med 2006; 31(3): 283–286.

14.

Sulek

Gravenstein

Blackshear

, et al. Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg 1996; 82(1): 125–128.

15.

Verghese

Nath

Zenger

, et al. The effects of the simulated Valsalva maneuver, liver compression, and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children. Anesth Analg 2002; 94: 250–254.

16.

Sargin

Uluer

Ozmen

Effects of incrementally increasing tidal volume on the right internal jugular vein in pediatric patients. J Vasc Access 2015; 16(4): 333–337.

17.

Grundeman

Borst

Verlaan

, et al. Hemodynamic changes with right lateral decubitus body positioning in the tilted porcine heart. Ann Thorac Surg 2001; 72(6): 1991–1996.

18.

Jung

Lee

Yoon

, et al. The effects of ipsilateral tilt position on right subclavian venous catheterization: study protocol for a prospective randomized trial. Trials 2018; 19(1): 292.