Differences in anatomical relationship between vertebral artery and internal jugular vein in children and adults measured by ultrasonography

Abstract

Cannulation of the internal jugular vein (IJV) under ultrasound guidance can reduce complications, such as common carotid artery (CCA) puncture, accidental vertebral artery (VA) puncture. However, these complications still occur, especially in pediatric patients probably due to anatomical predisposition of VA. This study compared differences in anatomical location of VA and IJV between pediatric and adult patients. Children with body weight <20 kg (n = 16) and adults who required central venous or pulmonary arterial pressure monitoring (n = 21) were enrolled. After induction of general anesthesia and tracheal intubation, patients were positioned for IJV cannulation. Images of the right CCA, IJV and VA were recorded by ultrasonography. The size of each vessel, anatomical relationship of other vessels, distance between vessels and between each vessel and skin were measured. The size of VA relative to IJV was significantly larger in children than in adults (14 vs 7 %, P < 0.001). The absolute and relative distance between IJV and VA were significantly shorter in children than those in adults (P < 0.01). The anatomical relationships between IJV and CCA and that between IJV and VA were not different between children and adults. In children, VA was relatively larger and located closer to IJV than adults. The results call for careful attention to the position of VA during ultrasound-guided IJV cannulation especially in children.

Position and relative size of the vertebral artery according to age: Implications for internal jugular vein access

“…In a previous pediatric study, the relative size of the right VA to the IJV at the cricoid level measured by ultrasonography was 14% in children <20 kg, and the mean value of the minimal distance between the VA and IJV was 4.3 mm . In our cohort with a similar body weight, the relative size of the VA to the IJV was greater (22.4% and 40.2% on the right and left sides, respectively, at the cricoid level) and the distance between the VA and IJV was greater (mean 6.0 mm in group 1) compared to those in the previous study.…”

“…Overlapping between the VA and IJV can contribute to the risk of inadvertent VA puncture during IJV catheterization. According to previous studies, about 40%‐82% of pediatric patients showed full or partial overlap between the VA and IJV on the right side . In our study involving chest CT in children at the neutral position, full or partial overlap was observed in 52%‐78% of children.…”

“…Although the incidence of VA injury during IJV cannulation is unclear, serious complications, including neurologic injury, hemothorax, and pseudoaneurysm may occur after VA injury . The risk of such complications is thought to be higher in children than in adults owing to the shorter distance between the VA and IJV, and the relatively larger size of the VA in children . Therefore, a previous report emphasized the importance of careful ultrasound‐guided IJV cannulation, especially in children, to avoid inadvertent VA cannulation .…”

“…The possibility of unintentional VA puncture is higher in children than in adults because the relative size of the VA to IJV is larger, and the distance between the IJV and VA is smaller in children. 4 However, this result was obtained in only 16 children aged 3-95 months, without information on the differences in side and puncture levels.…”

Anatomic variations of neck vessels and the course of pediatric internal jugular veins

“…Accidental puncture of the vertebral artery is another reported complication, as the vertebral artery is proximal to the internal jugular vein in infants and children . Our results indicate that almost all of the vertebral artery lies posteriorly laterally to the internal jugular vein in all planes.…”