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Published on: November 11, 2012
Simple manoeuvre to reduce the overlap between the internal jugular vein and carotid artery in infants
1Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju Special Self-governing Province, Korea.
Insights
A simple maneuver, caudo-lateral traction of the ipsilateral arm (CLTIA), effectively reduced internal jugular vein (IJV) and carotid artery (CA) overlap in infants. This technique shows promise for improving IJV catheterization success rates.
Area of Science:
- Pediatric Anesthesiology
- Vascular Ultrasound
- Medical Device Innovation
Background:
- Internal jugular vein (IJV) catheterization in infants presents challenges due to anatomical variations.
- Head rotation can increase overlap between the IJV and the carotid artery (CA), complicating cannulation.
- A novel maneuver is investigated to mitigate this overlap during infant IJV access.
Purpose of the Study:
- To evaluate the efficacy of caudo-lateral traction of the ipsilateral arm (CLTIA) in reducing IJV-CA overlap in infants.
- To assess the impact of CLTIA across varying degrees of head rotation.
- To determine if CLTIA improves anatomical visualization for pediatric central venous access.
Main Methods:
- Ultrasound imaging was used to assess IJV-CA overlap in 25 infants.
- Measurements were taken before and after CLTIA with the head at 0°, 40°, and 80° rotation.
- Overlap was quantified as a percentage of the CA diameter.
Main Results:
- CLTIA significantly decreased IJV-CA overlap on both right and left sides at all tested head rotation angles (P < 0.01).
- The maneuver was effective in reducing overlap even with substantial head rotation (up to 80°).
- Quantitative ultrasound analysis confirmed the spatial separation of IJV and CA facilitated by CLTIA.
Conclusions:
- Caudo-lateral traction of the ipsilateral arm (CLTIA) is a successful maneuver for reducing IJV-CA overlap in infants.
- This technique may enhance the safety and efficacy of internal jugular vein catheterization in pediatric patients.
- Further research is warranted to confirm the clinical utility of CLTIA in routine IJV cannulation procedures.
Background:
Catheterisation of the internal jugular vein (IJV) can be difficult in infants. We aimed to evaluate whether a simple manoeuvre, a slight caudo-lateral traction of the ipsilateral arm (CLTIA), could decrease the head rotation-induced overlap of the IJV to the carotid artery (CA) in infants.
Methods:
Twenty-five infants were included. The patients were placed in the 10° Trendelenburg position with a shoulder roll. On both sides of the neck, ultrasound images were obtained in a transverse orientation before and after the CLTIA at 0°, 40°, and 80° of head rotation, respectively. On each image, CA overlap was calculated as follows: CA overlap (%) = (overlap distance/CA diameter) × 100.
Results:
The CLTIA decreased CA overlap (%) in 0°, 40°, and 80° of head rotation on the right side of the neck [14 (interquartile range, IQR 0-32) to 0 (IQR 0-14), 24 (IQR 0-46) to 0 (IQR 0-33), and 31 (IQR 12-58) to 23 (IQR 0-34); all P < 0.01] and on the left [29 (IQR 7-61) to 19 (IQR 0-44), 40 (IQR 21-65) to 31 (IQR 0-46), and 44 (IQR 29-97) to 33 (IQR 14-69); all P < 0.01], respectively.
Conclusion:
The CLTIA successfully reduced the overlap between the IJV and the CA in infants. However, further study should be needed to evaluate the clinical usefulness of the CLTIA during the IJV catheterisation.
