title: Ultrasound analysis of the relationship between right internal jugular vein and common carotid artery in the left head-rotation and head-flexion position.
abstract: Common carotid artery (CCA) injury is a serious complication of internal jugular vein (IJV) cannulation. To minimize unintentional CCA puncture, the anatomic relationship between the IJV and the CCA and the size of IJV were compared under different head positions. Ultrasound analyses of the IJV and the CCA were performed in 103 consecutive patients. Overlapping angle (OA), real puncture angle (RPA) and diameter of IJV (D IJV) were evaluated with 30° and 60° left rotation and with 30° left flexion. When the head position was changed from 30° left rotation to 60° left rotation, OA increased significantly from 6.5° ± 7.7° to 14.5° ± 7.4° at the cricoid cartilage level (Cricoid-level) and from 14.4° ± 8.4° to 20.6° ± 6.9° at the middle triangle level (Triangle-level), whereas RPA decreased significantly at these levels (from 49.7° ± 11.9° to 43.5° ± 13.1° and from 51.1° ± 14.4° to 44.3° ± 13.9°, respectively; P < 0.01 for both). When the head position was changed from 30° left rotation to 30° left flexion, neither OA nor RPA significantly changed (OA: 6.3° ± 6.1° and 15.0° ± 7.2°, RPA: 48.5° ± 12.4° and 51.8° ± 13.6°, P not significant vs 30° left rotation). There was no difference in D IJV when comparing 30° left rotation and 30° left flexion, although D IJV was largest at 60° left rotation. RPA positively correlated with age, and D IJV positively correlated with body mass index. In conclusion, excessive left rotation should be avoided to minimize the probability of unintentional CCA puncture during IJV cannulation. When 30° left rotation is not feasible, the head-flexion position should be utilized.
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
authors.forename: Takeji
authors.initials: T
authors.lastname: Saitoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Azumi
authors.initials: A
authors.lastname: Kumazawa
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nobuhara
authors.forename: Masashi
authors.initials: M
authors.lastname: Machii
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Katsunori
authors.initials: K
authors.lastname: Shiraki
authors.forename: Masao
authors.initials: M
authors.lastname: Saotome
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Urushida
authors.forename: Hideki
authors.initials: H
authors.lastname: Katoh
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hayashi
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks; D020212:Carotid Artery Injuries / Q000209:etiology / Q000517:prevention & control; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D019416:Head Movements; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056888:Patient Positioning; D011237:Predictive Value of Tests; D011677:Punctures; D012399:Rotation; D018084:Ultrasonography, Interventional