Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation

Abstract

Ultrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheterrelated complications in high-risk hemodialysis patients. For this procedure, clinicians should identify the optimum positions of the RIJV, including its lower overlap with the carotid artery (CA) and high cross-sectional area of the vein. The aim of this prospective randomized study to evaluate the effects of mild ipsilateral head rotation combined with Trendelenburg position on RIJV cross-sectional area and its relation to the CA in adult patients. Forty ASA I-II patients who were undergoing elective surgery were enrolled for this study. The subjects were asked to remain supine in the 15-20Trendelenburg position. Two-dimensional ultrasound was then used to measure the degree of overlap between the RIJV and CA, the cross-sectional area of the RIJV. These measurements were compared between head rotation to the >30 left, <30 left, neutral, and <30 right positions. When the head was in the >30 left position, overlap was seen in 38 of 40 patients (95%). As the head was rotated from >30 left to <30 right, the CA-RIJV overlap (from 95% to 57.5%), and the cross-sectional area (from 14.2 mm to 8.7 mm) significantly decreased. In conclusion, when the head was turned to <30 right, the CA-RIJV overlap significantly decreased, and the cross-sectional area also decreased. When clinicians determine the optimal head position before RIJV cannulation, it is important to consider the advantages and disadvantages of the different head positions from >30 left to <30 right.

Anatomical relationship of the internal jugular vein and the common carotid artery in Korean : A computed tomographic evaluation

“…SR30 to the contralateral side resulted in anterior venal shift [2,3,6,8,[11][12][13][14][15][16]. These studies have shown that the IJV is commonly positioned lateral or anterolateral to the CCA, and the incidence of overlap was reported to be between 6 and 95%, depending on the method of calculation.…”

“…Although there is a high success rate (95%) when these landmarks are used [3], unexpected positional or anatomic variations of the CCA could result in inadvertent puncture of the CCA; this occurs in 3 to 10.6% of cases [4,5]. CCA punctures may result from an increased degree of overlap between the IJV and the CCA, and previous studies have shown variation in this overlap [3,[6][7][8].…”

Anatomical review of internal jugular vein cannulation

“…A summary of findings from several studies is shown (Table III). The CT-based studies determined the maximal diameter while USG measured the anteroposterior, transverse, or lateral diameters [32,87,113]. The average diameter obtained from USG showed a smaller average than CT, which was likely related to compression of the IJV during the procedure.…”

Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients

“…[2][3][4] In addition, the right IJV has a much wider diameter and runs more superficially than the left IJV, and anatomical variations of the left IJV may partly account for the difficulty in achieving successful cannulation of the left IJV in certain patients. 10 Hemodialysis patients generally have an increased risk of catheter complications because of impaired hemostasis secondary to platelet dysfunction and repeated catheterization of the IJVs with large-bore dialysis catheters. 11,12 Vascular perforation and rupture may complicate catheter insertion, especially in older patients with multiple vascular problems due to thrombotic complications and decreased elasticity of the vessels.…”

“…3,4,29 When the head is rotated away from the midline, the IJV becomes more directly anterior to the CA, resulting in a greater overlap of the IJV and the CA. 10 Therefore, excessive left rotation should be avoided to minimize the risk of unintentional CA puncture during right IJV cannulation. In the present study, each patient's head was positioned with the head rotated left at [20][21][22][23][24][25][26][27][28][29][30] .…”