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Trendelenburg position, head elevation and a midline position optimize right internal jugular vein diameter

[La position de Trendelenburg, l’élévation de la tête et une position médiane augmentent le diamètre de la veine jugulaire interne droite]

From the Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Gareth Parry, Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. Phone: 029 2074 3110; Fax: 029 2074 7203; E-mail: garethandantonia{at}ntlworld.com

Purpose: The right internal jugular (RIJ) is commonly used to provide central venous access, and success of cannulation shows a positive correlation with the vein’s diameter. The purpose of this study is to establish the patient position resulting in the largest RIJ diameter.

Method: 2D ultrasound was used to measure RIJ diameter, in varying body positions, in 21 healthy volunteers.

Results: In the neutral position (table flat, head on the table in midline) the RIJ diameter was (mean ± standard deviation) 9.2 ± 2.18 mm. A small pillow under the head increased RIJ diameter (10.6 ± 2.16 mm, P < 0.001). Trendelenburg tilt of 15° increased RIJ diameter (12.1 ± 2.34 mm, P < 0.001). In the Trendelenburg position (15° of tilt), a small pillow under the head further increased RIJ diameter (13.3 ± 2.26, mm P < 0.001), palpating for the carotid artery decreased RIJ diameter (8.2 ± 1.98 mm, P < 0.001), and rotation of the head 45° to the left did not reduce RIJ diameter significantly (11.7 ± 2.52 mm, P = 0.12).

Conclusion: The patient position to achieve maximal RIJ diameter cannulation is: 15° of Trendelenburg tilt; a small pillow or head ring under the head; the head in or close to midline; and after palpation of the carotid artery, it should be released prior to vein cannulation.

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