Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients.
OBJECTIVE
Trendelenburg positioning (TP) is a common approach used during internal jugular vein (IJV) cannulation. No evidence indicates that TP significantly increases the cross-sectional area (CSA) of the IJV or decreases the overlap between the carotid artery (CA) and the IJV in dialysis patients. The primary aim of this study was to investigate the effects of the TP on the CSA of the right IJV and on its relationship to the CA.


METHODS
Thirty-seven consecutive hemodialysis patients older than 18 years of age were enrolled. We measured the CSA of the right IJV and overlap rate (at end-expiration at the level of the cricoid cartilage) between the CA and the IJV in two positions: State 0, table flat (no tilt), with the patient in the supine position; State T, in which the operating table was tilted to 15° of TP.


RESULTS
Data were collected for all of the 37 patients enrolled in the study. The change in CSA and overlap between the CA and the IJV from the supine to the TP was not significantly different. The CSA was paradoxically decreased in 11 of 37 patients when changed from State 0 to State T.


CONCLUSIONS
TP does not significantly increase the CSA of the right IJV or decrease the overlap between the CA and the IJV in dialysis patients. In fact, in some patients, it reduces the CSA. Therefore, the use of the TP for IJV cannulation in dialysis patients can no longer be supported.
a Department of Radiology .
Alaaddin
A
Nayman
b Department of Anesthesiology and Intensive Care , and.
Ibrahim Ozkan
IO
Onal
b Department of Anesthesiology and Intensive Care , and.
Seza
S
Apiliogullari
a Department of Radiology .
Seda
S
Ozbek
b Department of Anesthesiology and Intensive Care , and.
Ali Ozgul
AO
Saltali
b Department of Anesthesiology and Intensive Care , and.
Jale Bengi
JB
Celik
a Department of Radiology .
Osman
O
Temizoz
c Division of Nephrology, Department of Internal Medicine , Selcuk University, Faculty of Medicine , Konya , Turkey.
Gulperi
G
Celik
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014463:Ultrasonography
Chronic; Trendelenburg position; dialysis; jugular vein; ultrasonography