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Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease

Marc A Bellazzini1, Peter M Rankin, Ronald E Gangnon

  • 1Division of Emergency Medicine, F2/208 CSC, University of Wisconsin Hospital, Madison, WI 53792-3280, USA. mabellazzini@wisc.edu

The American Journal of Emergency Medicine
|June 27, 2009
PubMed
Summary
This summary is machine-generated.

Valsalva maneuver and Trendelenburg position significantly increase internal jugular vein (IJV) cross-sectional area (CSA) during simulated venipuncture. Valsalva alone or combined with other maneuvers was most effective in increasing IJV CSA and preventing collapse.

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Area of Science:

  • Ultrasound imaging
  • Vascular anatomy
  • Emergency medicine procedures

Background:

  • Internal jugular vein (IJV) ultrasound is crucial for central line placement.
  • Optimizing IJV visualization and minimizing collapse during venipuncture is essential for successful procedures.

Purpose of the Study:

  • To determine which maneuvers maximize internal jugular vein (IJV) cross-sectional area (CSA).
  • To identify maneuvers that reduce IJV collapsibility during simulated venipuncture using ultrasound.

Main Methods:

  • Prospective study of 52 healthy volunteers in an academic emergency department.
  • Ultrasound measurements of IJV CSA at baseline and during Valsalva maneuver, hepatic pressure, and combined maneuvers.
  • Simulated venipuncture using transducer pressure to assess IJV collapse.

Main Results:

  • Valsalva maneuver and Trendelenburg position significantly increased IJV CSA (P < .0001) during simulated venipuncture.
  • Valsalva maneuver, alone or in combination, yielded the largest IJV CSA (CRADE up to 1.20 cm).
  • Hepatic pressure did not significantly impact IJV CSA (P = .94).

Conclusions:

  • Valsalva maneuver and Trendelenburg position effectively increase IJV CSA and reduce collapsibility.
  • Valsalva maneuver is the most effective maneuver for increasing IJV CSA by over 50% and preventing collapse during simulated venipuncture.