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Trendelenburg position does not increase cross-sectional area of the internal jugular vein predictably

Boulos Nassar1, Gur Raj S Deol1, Andrew Ashby1

  • 1Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA.

Chest
|February 9, 2013
PubMed

Insights

Trendelenburg positioning offers minimal increase in internal jugular vein size compared to supine. In some cases, this position may even decrease vein cross-sectional area, impacting vascular cannulation.

Area of Science:

  • Medical Imaging and Ultrasound
  • Vascular Anatomy
  • Anesthesiology

Background:

  • The Trendelenburg position is utilized to enhance central vein visualization for vascular cannulation.
  • This study investigates the impact of body positioning on internal jugular vein dimensions.

Purpose of the Study:

  • To quantitatively assess the cross-sectional area (CSA) of the internal jugular vein (IJV) in three distinct body positions: reverse Trendelenburg, supine, and Trendelenburg.
  • To determine the effect of these positions on IJV distension for potential procedural benefits.

Main Methods:

  • Fifty-one subjects were included in this ultrasonography study.
  • Surface ultrasonography with a 10.5-mHz linear probe was used to measure IJV CSA.
  • Measurements were taken at end-expiration at the cricoid cartilage level in 15° reverse Trendelenburg, supine, and 15° Trendelenburg positions.

Main Results:

  • The mean IJV CSA was 0.83 cm² in reverse Trendelenburg, 1.25 cm² supine, and 1.47 cm² in Trendelenburg.
  • The CSA increased by 50% from reverse Trendelenburg to supine.
  • Trendelenburg positioning resulted in a modest 17% average CSA increase, with a surprising decrease in nine subjects.

Conclusions:

  • Trendelenburg positioning provides only a modest average increase in IJV CSA compared to the supine position.
  • In a subset of patients, Trendelenburg positioning can paradoxically reduce IJV CSA, which may have implications for vascular access procedures.
Abstract

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