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Relationship between Trendelenburg tilt and internal jugular vein diameter
S Clenaghan1, R E McLaughlin, C Martyn
1Ulster Hospital, Belfast, Northern Ireland. stepclen@hotmail.com
Emergency Medicine Journal : EMJ
|November 22, 2005
Summary
Trendelenburg tilt increases internal jugular vein (IJV) diameter, with even a 10-degree tilt proving effective. Cumulative tilt effects were not significant, but increased tilt enhances IJV size for potential cannulation.
Area of Science:
- Anesthesiology
- Vascular Ultrasound
- Anatomical Studies
Background:
- The internal jugular vein (IJV) is a critical landmark for central venous access.
- Optimizing IJV visualization can improve cannulation success rates.
- Trendelenburg tilt is a maneuver used to alter venous pressures and potentially affect vessel diameter.
Purpose of the Study:
- To determine the relationship between varying degrees of Trendelenburg tilt and the lateral diameter of the IJV.
- To investigate whether cumulative Trendelenburg tilt exposure has a significant effect on IJV diameter.
Main Methods:
- Healthy volunteers underwent Trendelenburg tilts ranging from 10 to 30 degrees using a tilt table.
- The right IJV diameter was measured using ultrasound at the cricoid cartilage level after each tilt.
- A balanced randomization scheme was employed to assess cumulative tilt effects.
Main Results:
- A statistically significant increase in mean IJV diameter was observed at a 10-degree Trendelenburg tilt compared to the supine position (15.5 mm vs. 13.5 mm).
- No significant differences in IJV diameter were found between 10 degrees and higher tilt angles (15, 20, 25, 30 degrees).
- The study found no statistically significant cumulative effect of previous tilt angles on the measured IJV diameter.
Conclusions:
- Increasing Trendelenburg tilt angle directly correlates with an increased lateral diameter of the IJV.
- A 10-degree Trendelenburg tilt is sufficient to significantly distend the IJV.
- While Trendelenburg tilt can aid IJV cannulation, especially without ultrasound guidance, extreme angles (e.g., 25 degrees) may not be practical or could pose risks like increased intracranial pressure.