Ultrasound evaluation of central veinsin the intensive care unit:effects of dynamic manoeuvres.
OBJECTIVE
To determine: (1) the proportion of small (<5 mm) or thrombosed internal jugular veins (IJV) and femoral veins (FV) in which catheter placement would be difficult without ultrasound guidance; (2) which position increases central vein sizes and may facilitate cannulation of these vessels.


METHODS
Prospective study.


METHODS
Twelve-bed adult medical intensive care unit.


METHODS
Sixty patients (62 +/- 19 years, SAPS II score 36 +/- 17).


METHODS
Ultrasound examinations of the IJV and FV in supine, Trendelenburg (T) and reverse Trendelenburg (Ti) positions.


RESULTS
Maximum diameter and cross-sectional area (CSA) were measured. Venous catheter placement would have been difficult (diameter < 5 mm) or even impossible (thrombosis) for 22% of right IJV, 13% of left IJV, 2% of left and 2% of right FV. In the T position, the CSA of the IJV increased (right IJV: 1.7 +/- 1.4 to 2.01 +/- 1.34 cm2, left IJV: 1.18 +/- 0.81 to 1.34 +/- 0.85 cm2; p < 0.05) and theCSA of the FV decreased (right FV: 1.42 +/- 0.61 to 1.22 +/- 0.58 cm2, left FV: 1.51 +/- 0.62 to 1.26 +/- 0.58 cm2; p < 0.05). In the Ti position, the CSA of the IJV decreased (right IJV: 1.7 +/- 1.4 to 1.35 +/- 1.35 cm2, left IJV: 1.18 +/- 0.81 to 0.87 +/- 0.62 cm2; p < 0.05) and the CSA of the FV increased (right FV: 1.42 +/- 0.61 to 1.66 +/- 0.65 cm2, left FV: 1.51 +/- 0.62 to 1.65 +/- 0.68 cm2; p < 0.05). In two-thirds of patients, the right IJV was significantly larger than the left IJV.


CONCLUSIONS
Ultrasonography should be performed before at least central venous catheter placement to detect the presence of deep vein thrombosis or vessels less than 5 mm in diameter. Some positions increase veins' diameter at least internally, T position increasing IJV size and Ti position increasing FV size.
Samy Modeliar
Santhi
S
Unité de réanimation, service de néphrologie, CHU sud, 80054 Cedex 1 Amiens, France. samymodeliar.santhi@chu-amiens.fr
Sevestre
Marie-Antoinette
MA
de Cagny
Bertrand
B
Slama
Michel
M
D000704:Analysis of Variance; D002405:Catheterization, Central Venous; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*