Head Rotation During Internal Jugular Vein Cannulation and the Risk of Carotid Artery Puncture

Abstract

We undertook a prospective laboratory study to examine the effect of head position on the relative positions of the carotid artery and the internal jugular vein (IJV). Volunteers (n = 12) from departmental staff, 18-60 yr of age, who had never undergone cannulation of the IJV underwent imaging of their IJV and carotid artery. With the subject in a 15 degrees Trendelenburg position, two-dimensional ultrasound images of the IJV and the carotid artery were obtained on the left and right sides of the neck at 2 and 4 cm from the clavicle along the lateral border of the sternal head of the sternocleidomastoid muscle at 0 degrees, 40 degrees, and 80 degrees of head rotation from the midline. The percent overlap of the carotid artery and IJV increased significantly at 40 degrees and 80 degrees head rotation to both the right and left (P < 0.05). Data from 2 and 4 cm above the clavicle did not differ and were pooled. The percent overlap was larger on the left than the right only with 80 degrees of head rotation (P < 0.05). The increased overlap of carotid artery and IJV with head rotation > 40 degrees increases the risk of inadvertent puncture of the carotid artery associated with the common occurrence of transfixion of the IJV before it is identified during needle withdrawal. The IJV frequently collapses with needle insertion. This may result in puncture of the posterior wall of the vessel, and thus of the carotid artery when the two vessels overlap. To decrease this risk, the head should be kept in as neutral a position as possible, that is < 40 degrees rotation, during IJV cannulation.

Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound

“…In the classical cannulation position (neck turned to contralateral side), the jugular vein overlaps the carotid artery in 70%–90%[91011] of the time and more so with increasing age[11] and with increasing degree of neck rotation. [1213] In our study, the anterolateral position of the IJV was seen in majority of patients. The true lateral position of vein to artery with no overlap was seen only in 3.3% of cases, similar to another study findings by Maecken et al .…”

Ultrasound evaluations of internal jugular vein punction techniques in children: the easiest method to reach the target area

“…On the other hand, there is an alteration of anatomical relations, superposing the RIJV to the common carotid artery, which increases the chance of accidental punction of the artery [6]. The extreme rotations have the inconvenience of making the IJV punction difficult [7] and also interfere in the ventilatory mechanic increasing the risk in the critical patients, mainly the newborn, who might have the oxymetry monitored during the procedures.…”

Anatomic considerations for central venous cannulation

“…Contralateral rotation of the head brings the sternocleidomastoid muscle into an anterior position over the internal jugular vein impeding cannulation,23 especially from the anterior approach 24. Contralateral rotation beyond 40° increases the anterior-posterior overlap of the internal jugular vein with the carotid artery, increasing the risk of arterial puncture 25.…”