title: The skin-traction method increases the cross-sectional area of the internal jugular vein by increasing its anteroposterior diameter.
abstract: OBJECTIVE
  We developed a novel "skin-traction method" in which the puncture point of the skin over the internal jugular vein (IJV) is stretched upward with several pieces of surgical tape in the cephalad and caudad directions to facilitate cannulation of the IJV. We investigated whether this method increases the cross-sectional area of the IJV.
  
  
  METHODS
  In 11 healthy volunteers, the cross-sectional area, anteroposterior diameter, and transverse diameter of the right IJV (RIJV) were recorded by ultrasound echo at head tilts of +10 degrees , +5 degrees , 0 degrees , -5 degrees , and -10 degrees with and without the skin-traction method.
  
  
  RESULTS
  The skin-traction method significantly increased the cross-sectional areas of the RIJV at head tilts of +10 degrees , +5 degrees , and 0 degrees . In the flat position, the skin-traction method increased the cross-sectional area of the RIJV from 1.21 +/- 0.44 cm(2) to 1.75 +/- 0.60 cm(2) (44.6% increase), which is almost the same as that in the Trendelenburg position without this method (1.60 +/- 0.54 cm(2) at -5 degrees and 1.83 +/- 0.56 cm(2) at -10 degrees ). The anteroposterior diameter of the RIJV was significantly increased in all positions with this method, although the transverse diameter was not.
  
  
  CONCLUSIONS
  This method significantly increased the cross-sectional area of the RIJV by increasing the anteroposterior diameter of the RIJV. Even in the flat position, this method was almost as efficacious as the Trendelenburg position. This method thus appears to facilitate IJV cannulation.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, 1 Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Morita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Takafumi
authors.initials: T
authors.lastname: Azami
authors.forename: Nobuko
authors.initials: N
authors.lastname: Sasano
authors.forename: Hirotada
authors.initials: H
authors.lastname: Katsuya
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D014143:Traction / Q000379:methods*