title: Circumferential adjustment of ultrasound probe position to determine the optimal approach to the internal jugular vein: a noninvasive geometric study in adults.
abstract: Circumferential adjustment of the position of a two-dimensional ultrasound (US) probe around the neck has been recommended as a strategy for reducing the potential for unintentional common carotid artery puncture during internal jugular venous (IJV) cannulation. We obtained multiple high-resolution US images bilaterally from the necks of 107 adult subjects and analyzed these to determine the degree to which this strategy permits identification of a pathway from the skin to the IJV that minimizes venoarterial overlap while maximizing venous target (angular) width. The method consistently permitted identification of an approach to the IJV superior to that obtainable with any one of four popular surface anatomy-based ("blind") approaches and was even more powerful if used in concert with a US-guided 1) adjustment of the degree of head rotation, 2) choice between a high and low approach, and 3) choice between the right and left IJV. Use of a high-resolution US imaging device also permitted identification of the precise boundaries of additional cervical anatomic structures (nontarget vessels, lymph nodes, and the thyroid gland) potentially relevant to selection of an optimal approach to the IJV.
authors.affiliation: Departments of *Anesthesiology, †Surgery, ¶Radiology, and ‡Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana; and §Department of Psychology, Louisiana State University, Baton Rouge, Louisiana.
authors.forename: James M
authors.initials: JM
authors.lastname: Riopelle
authors.forename: Darren P
authors.initials: DP
authors.lastname: Ruiz
authors.forename: John P
authors.initials: JP
authors.lastname: Hunt
authors.forename: Mark R
authors.initials: MR
authors.lastname: Mitchell
authors.forename: J Carlos
authors.initials: JC
authors.lastname: Mena
authors.forename: Jason A
authors.initials: JA
authors.lastname: Rigol
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Jubelin
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Riopelle
authors.forename: Valeriy V
authors.initials: VV
authors.lastname: Kozmenko
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Miller
mesh_terms: D000368:Aged; D002404:Catheterization; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D012399:Rotation; D014463:Ultrasonography