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

Jung, Chul-Woo; Jalilov, Gulomjon; Song, In Kyung; Kim, Eun‐Hee; Kim, Hee‐Soo; Kim, Jin‐Tae; Lee, Ji Hyun

doi:10.1111/pan.13209

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…Although arterial puncture rates between 4.3 and 25% have been reported [26], puncture of the internal carotid artery with an introducer needle did not occur in our patients. However, we need to be aware that carotid artery injury is one of the most serious complications of IJV catheterization [27].…”

Section: Discussioncontrasting

confidence: 65%

Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery

Xie

et al. 2019

BMC Anesthesiol

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Background This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA. Methods Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees ( n = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared. Results The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm 2 , 1.65 ± 0.73 cm 2 , and 1.68 ± 0.71 cm 2 , respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position ( P = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles ( P = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups ( P = 0.674). Conclusions PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased. Trial registration Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.

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Section: Discussioncontrasting

confidence: 65%

Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery

Xie

et al. 2019

BMC Anesthesiol

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“…Except for the vertebral artery, numerous branches of the subclavian artery approach the posterior wall of the IJV, which can be punctured at the lower neck level. Therefore, when IJV catheterization is performed, the puncture point is lower along the patient's neck, and the risk of vertebral artery puncture is greater ( 11 , 24 ). The level of the CC approximates the level of the apex of the sternocleidomastoid muscle triangle, both of which are located on the midsection of the longitudinal axis of the neck.…”

Section: Discussionmentioning

confidence: 99%

The Right Internal Jugular at the Cricoid Cartilage Level May Represent the Optimal Central Vein Puncture Site in Pediatric Patients

et al. 2022

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ObjectiveInternal jugular vein puncture or cannulation is far more difficult in children compared with adults. Anthropometric measures of the internal jugular vein acquired by two-dimensional ultrasound are useful in the practice of puncture and catheterization. The aim of this study is to measure anthropometric parameters of bilateral internal jugular veins in children and to determine the best puncture site based on these parameters.MaterialsA total of 107 pediatric patients undergoing elective operation were included. Ultrasound-visible evaluation of bilateral internal jugular veins was used to obtain the depth from skin, maximum antero-posterior diameter, and cross-sectional area at the levels of the superior border of thyroid cartilage and cricoid cartilage. Statistical analysis was performed using these anthropometric data and demographic variables of all studied pediatric patients, such as age, height, and weight.ResultsA very weak correlation was noted between the depth, maximal antero-posterior diameter, and cross-sectional area of both internal jugular veins and the age, height, weight, and body surface index of all included children. All Pearson's R correlation coefficients were <0.45. The largest diameter and cross-sectional area were in the right internal jugular vein at the cricoid cartilage level (p < 0.01) followed by the left internal jugular vein at this level (p < 0.01). In addition, the internal jugular vein at the cricoid cartilage level was more superficial than that of the superior border of the thyroid cartilage (p < 0.01).ConclusionThe right internal jugular vein at the cricoid cartilage level is the best site for puncture. The most appropriate alternative site is the left internal jugular vein on the same level. Better correlation was not observed between the anthropometric parameters of the internal jugular vein and children's biological characteristics. This finding should be confirmed in a larger-scale demographical study in the future.

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“…Although the success rate of IJV cannulation using anatomical landmarks is 95%, various parameters such as obesity, neck deformity, and inability to lie flat may make the procedure difficult [ 12 , 13 ]. Ultrasound may be of help in such cases to prevent brachial plexus injury [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction

Modi¹,

Goel²,

Sharma³

et al. 2021

JOCR

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Introduction: Internal Jugular Venous (IJV) cannulation or central-line insertion is frequently performed during kyphoscoliosis deformity correction surgery or spine surgery with high risk. This helps monitor central venous pressure and administer medicines when required. Although many complications of IJV cannulation have been reported in the literature, its effect on brachial plexus is not known. The objective of this paper was to report a rare complication of IJV during scoliosis surgery. Case Presentation: We reported a case of 27-year-old male who was operated for severe kyphoscoliosis correction where preoperatively IJV cannulation was done. Repeated attempts were done during IJV cannula insertion due to altered anatomy. Eventually, cannula insertion was done using ultrasound modality and surgery for correction was done. Postoperatively patient developed right upper extremity weakness and sensory loss although the clinical result of kyphoscoliosis correction was acceptable. EMG-NCV study proved it brachial plexus injury. The patient was treated with intravenous steroid and physiotherapy. The patient recovered completely within 6 months of surgery. Conclusion: We reported a case of kyphoscoliosis deformity corrective surgery where IJV cannulation led to brachial plexus injury and was eventually recovered with medications and physiotherapy. Keywords: Scoliosis correction, Central-line insertion, Brachial plexus injury.

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

Abstract: The theoretical risk of vertebral artery puncture is higher in younger children during internal jugular vein catheterization.

Cited by 8 publications

References 18 publications

Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery

Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery

The Right Internal Jugular at the Cricoid Cartilage Level May Represent the Optimal Central Vein Puncture Site in Pediatric Patients

Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction

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