title: No enlargement of the right internal jugular vein of the dialysis patients in the Trendelenburg position.
abstract: BACKGROUND
  The Trendelenburg position has been suggested for right internal jugular vein (RIJV) catheterization. However, this position can sometimes be functionally intolerable for chronic kidney disease patients. We conducted an ultrasound study to further investigate the efficacy of the use of the Trendelenburg position during tunneled dialysis catheter insertion via the RIJV in chronic kidney disease patients.
  
  
  METHODS
  We recruited into our study patients without a history of prior tunneled dialysis catheter insertion or neck surgery. Those patients with stenosis or thrombus in the RIJV were excluded. Serial ultrasound images were acquired with patients in the supine position, with the head rotated 30° to the left: Stage 0, table flat; Stage T, Trendelenburg tilt. Then, measurements of patient RIJV transverse diameter, anteroposterior (AP) diameter, and cross-sectional area (CSA) were obtained.
  
  
  RESULTS
  Fifty dialysis patients and 40 healthy volunteers completed the study. There were no significant differences in the lateral diameter, AP diameter, or AP/lateral diameter ratio between the dialysis patients and healthy volunteers, whether in the supine or the Trendelenburg position. However, the CSA of the RIJV of the healthy volunteers in the Trendelenburg position was significantly larger than that in dialysis patients. The change in CSA from the supine to the Trendelenburg position was also significantly different between the two groups.
  
  
  CONCLUSIONS
  In contrast to healthy volunteers, there was no enlargement of the RIJV when dialysis patients were in the Trendelenburg position. The reason for this phenomenon may be multifactorial, with diastolic dysfunction being the most likely cause, and further investigation is required to clarify the cause. Our investigation suggests that the supine position for central venous catheterization in dialysis patients is superior to the Trendelenburg position.
authors.affiliation: Department of Anesthesiology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan, ROC.
authors.forename: Hsin-Lun
authors.initials: HL
authors.lastname: Wu
authors.forename: Chien-Kun
authors.initials: CK
authors.lastname: Ting
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Chen
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Cheng
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.forename: Pin-Tarng
authors.initials: PT
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D018475:Head-Down Tilt; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D016683:Supine Position