title: Is a neutral head position as effective as head rotation during landmark-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial.
abstract: OBJECTIVE
  Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn.
  
  
  METHODS
  A prospective, randomized, controlled study.
  
  
  METHODS
  An education and research hospital and a university-affiliated hospital.
  
  
  METHODS
  Eighty patients requiring central venous catheterization in the right IJV.
  
  
  METHODS
  Under general anesthesia, patients were positioned in the Trendelenburg position with extension of the neck. In the rotated group, the head was rotated to the left at >45°. In the neutral group, the head was placed in the neutral position. Right IJV cannulation was performed using the central approach with the needle angled toward the ipsilateral nipple. The primary outcome variable was the cumulative success rate, which was defined as IJV puncture achieved in the first 3 attempts using a finder needle. A p value of <0.05 was considered statistically significant.
  
  
  RESULTS
  Groups were similar in terms of demographic data. The success rates of finder needle passes into the IJV on the first attempt were 87.5% and 37.5% (p < 0.05), and the cumulative success rates on the first 3 attempts were 97.5% and 57.5% in the rotated and neutral groups, respectively (p < 0.05). Carotid artery puncture only occurred in 2 patients in the rotated group.
  
  
  CONCLUSIONS
  Because of the lower success rate, the neutral head position is not an attractive alternative for IJV catheterization when compared with the rotated head position in a central landmark IJV approach.
authors.affiliation: Department of Thoracic Surgery, Konya Education and Research Hospital, Konya, Turkey. bapiliogullari@yahoo.com
authors.forename: Burhan
authors.initials: B
authors.lastname: Apiliogullari
authors.forename: Inci
authors.initials: I
authors.lastname: Kara
authors.forename: Seza
authors.initials: S
authors.lastname: Apiliogullari
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Arun
authors.forename: Ali
authors.initials: A
authors.lastname: Saltali
authors.forename: Jale Bengi
authors.initials: JB
authors.lastname: Celik
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006257:Head / Q000098:blood supply / Q000502:physiology; D006801:Humans; D007601:Jugular Veins / Q000502:physiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012399:Rotation