Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

Abstract

Aim: The most common complication following internal jugular vein catheterization is the puncture of the common carotidartery. We aimed to find an optimal head rotation angle for safe vein catheter insertion while minimizing the risk of arterypuncture.Materials and methods: Eighty-two patients admitted to the intensive care unit were included in the prospective study. Ultrasound examination of the neck vessels on the right side was performed in the neutral position and at a head rotation of 15°, 30°, 45° and 60° to the left. Internal jugular vein and common carotid artery puncture angle, overlapping angle of vein by artery and vein safe puncture angle were evaluated.Results: The internal jugular vein puncture angle increased with head rotation from the neutral position to 30° and 45° and was largest at 60° (p<0.001 for all). The overlapping angle increased significantly at 45° and 60° rotation compared with the neutral position (p<0.001 for all). The vein safe puncture angle was highest at 30° and significantly different from the neutral position and 60° (p=0.003 and p=0.013, respectively).Conclusions: When performing right internal jugular vein catheterization without ultrasound guidance by using an out-of-plane technique, the head should be rotated at 30°, because the overlapping angle increases with further head rotation and can increase the risk of artery puncture.

Carotid Artery Aneurysm-Induced Mediastinal Hematoma Leading to Airway Compression—A Rare Complication of Internal Jugular Vein Puncture

“…11 During the puncture, it is important to avoid excessive rotation, particularly over 40° of left rotation, as this can lead to increased blood vessel overlap. 19 If a 30° rotation is not feasible, the head-flexion position may be necessary. 20 Thirdly, using a fine needle to locate the vein and gently sticking with bevel-down approach can reduce the common carotid artery injury and hematoma formation.…”

Massive hemothorax secondary to internal jugular vein central venous catheter placement in a patient undergoing spinal surgery complicated by chest trauma: a case report

“…CVC placement is associated with a range of complications [3]. The development and application of ultrasound technology have improved the safety and quality of CVC placement [9].…”

“…the placement of a central venous catheter (CVC) has become the preferred choice in patients undergoing trauma surgery due to increased safety [2]. CVC placement is predominantly performed using the subclavian, internal jugular, or femoral veins [3]. Subclavian venipuncture has a high incidence of pneumothorax and femoral venous puncture is associated with an increased risk of infection [4,5].…”

Ultrasonographic Assessment of Anatomic Relationship Between the Internal Jugular Vein and the Common Carotid Artery in Infants and Children After ETT or LMA Insertion: A Prospective Observational Study

“…They demonstrated that the percent overlap of the CCA and the IJV increased significantly at 40 and 80 • head rotation to both sides of the neck. Vosylius et al (19) studied the overlapping angle of the IJV by the CCA in 82 patients under neutral head position and at a head rotation of 15, 30, 45, and 60 • to the left. They found that the overlapping angle increased significantly at 45 and 60 • head rotation compared with the neutral head position.…”