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Relationship between the right internal jugular vein and carotid artery at ipsilateral head rotation

Seda Ozbek1, Seza Apiliogullari, Ali Sami Kıvrak

  • 1Department of Radiology, Medical Faculty, Selcuk University, Konya, Turkey. dsadr@hotmail.com

Renal Failure
|May 9, 2013
PubMed

Insights

Mild right head rotation (<30°) combined with Trendelenburg position optimizes ultrasound-guided right internal jugular vein catheterization by reducing carotid artery overlap and vein cross-sectional area, crucial for high-risk hemodialysis patients.

Area of Science:

  • Vascular Access Procedures
  • Ultrasound Guidance
  • Anatomical Relationships

Background:

  • Ultrasound-guided right internal jugular vein catheterization (RIJV) is preferred for high-risk hemodialysis patients to minimize complications.
  • Optimal RIJV cannulation requires identifying positions with minimal overlap with the carotid artery (CA) and a large vein cross-sectional area.

Purpose of the Study:

  • To evaluate the impact of mild ipsilateral head rotation and Trendelenburg position on RIJV cross-sectional area and its relationship with the CA.
  • To determine the optimal head position for RIJV catheterization in adult patients.

Main Methods:

  • Prospective randomized study involving 40 ASA I-II adult patients undergoing elective surgery.
  • Patients were placed in a 15-20° Trendelenburg position.
  • Two-dimensional ultrasound measured CA-RIJV overlap and RIJV cross-sectional area across four head positions: >30° left, <30° left, neutral, and <30° right.

Main Results:

  • Head rotation to >30° left resulted in 95% CA-RIJV overlap.
  • Rotating the head from >30° left to <30° right significantly decreased CA-RIJV overlap (95% to 57.5%) and RIJV cross-sectional area (14.2 mm to 8.7 mm).
  • A <30° right head position showed significantly reduced overlap and cross-sectional area.

Conclusions:

  • Mild right head rotation (<30°) in conjunction with the Trendelenburg position significantly reduces CA-RIJV overlap.
  • This head position also decreases RIJV cross-sectional area, which may influence cannulation success.
  • Clinicians must weigh the benefits and drawbacks of various head positions when performing RIJV cannulation.

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