title: Simple manoeuvre to reduce the overlap between the internal jugular vein and carotid artery in infants.
abstract: BACKGROUND
  Catheterisation of the internal jugular vein (IJV) can be difficult in infants. We aimed to evaluate whether a simple manoeuvre, a slight caudo-lateral traction of the ipsilateral arm (CLTIA), could decrease the head rotation-induced overlap of the IJV to the carotid artery (CA) in infants.
  
  
  METHODS
  Twenty-five infants were included. The patients were placed in the 10° Trendelenburg position with a shoulder roll. On both sides of the neck, ultrasound images were obtained in a transverse orientation before and after the CLTIA at 0°, 40°, and 80° of head rotation, respectively. On each image, CA overlap was calculated as follows: CA overlap (%) = (overlap distance/CA diameter) × 100.
  
  
  RESULTS
  The CLTIA decreased CA overlap (%) in 0°, 40°, and 80° of head rotation on the right side of the neck [14 (interquartile range, IQR 0-32) to 0 (IQR 0-14), 24 (IQR 0-46) to 0 (IQR 0-33), and 31 (IQR 12-58) to 23 (IQR 0-34); all P < 0.01] and on the left [29 (IQR 7-61) to 19 (IQR 0-44), 40 (IQR 21-65) to 31 (IQR 0-46), and 44 (IQR 29-97) to 33 (IQR 14-69); all P < 0.01], respectively.
  
  
  CONCLUSIONS
  The CLTIA successfully reduced the overlap between the IJV and the CA in infants. However, further study should be needed to evaluate the clinical usefulness of the CLTIA during the IJV catheterisation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju Special Self-governing Province, Korea.
authors.forename: A-R
authors.initials: AR
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: H-Y
authors.initials: HY
authors.lastname: Lim
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
mesh_terms: D000768:Anesthesia, General; D002339:Carotid Arteries / Q000033:anatomy & histology; D002405:Catheterization, Central Venous / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006257:Head; D018475:Head-Down Tilt; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000033:anatomy & histology; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D012399:Rotation; D016037:Single-Blind Method