title: Trendelenburg position, simulated Valsalva maneuver, and liver compression do not alter the size of the right internal jugular vein in patients with a bidirectional Glenn shunt.
abstract: BACKGROUND
  Ultrasound is increasingly used to facilitate right internal jugular vein (RIJV) cannulation in children. In children without cardiac disease, position changes and enhancement maneuvers increase RIJV cross-sectional area (CSA) and further facilitate cannulation. We investigated the effect of these maneuvers on RIJV CSA in children with a bidirectional Glenn (BDG) shunt presenting for a Fontan procedure.
  
  
  METHODS
  The CSA (cm(2)) of the RIJV in 21 children with a BDG shunt presenting for a Fontan procedure was assessed by ultrasonic planimetry (SonoSite). Two positions, supine (S) and 15 degrees Trendelenburg (T); and two enhancements maneuvers, manual liver compression (L) and a simulated Valsalva maneuver (V) were utilized in combination. Eight separate measurements (S, S + L, S + V, S + L + V, T, T + L, T + V, T + L + V) were made in each patient. Data were analyzed using one-way analysis of variance with repeated measures and with Tukey post hoc pairwise comparison analysis.
  
  
  RESULTS
  No significant change in the RIJV CSA or % change in CSA from baseline (S) was observed.
  
  
  CONCLUSIONS
  Position changes and enhancement maneuvers are unlikely to facilitate RIJV cannulation in BDG shunt patients presenting for Fontan procedure because these interventions do not increase RIJV CSA.
authors.affiliation: Cardiac Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuki
authors.forename: Kelly
authors.initials: K
authors.lastname: Chilson
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Odegard
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D018610:Heart Bypass, Right / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000502:physiology*; D008099:Liver / Q000502:physiology*; D008297:Male; D014636:Valsalva Maneuver / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology