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Indian Journal of Critical Care Medicine
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Year : 2017  |  Volume : 21  |  Issue : 3  |  Page : 160--162

Using ultrasonography to determine optimal head-down tilt position angle in patients before catheterization of the internal jugular vein


1 Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk; Department of Anesthesiology and Intensive Care, Clinical Hospital, Izhevsk, Russia
2 Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia
3 Department of Anesthesiology and Intensive Care, Clinical Hospital, Izhevsk, Russia

Correspondence Address:
Anton A Kasatkin
Karl Marks Street 278-45, 426008 Izhevsk
Russia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijccm.IJCCM_299_16

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Context: It is believed that 15°–25° head-down tilt position increases the internal jugular vein cross-sectional area (IJV CSA). The increase in IJV CSA before puncture reduces the risk of its perforation. This pattern was not observed in all patients. We assumed that the absence of respiratory-based IJV excursion is one of the criteria of head-down tilt position effectiveness. Aims: The aim of this study is to determine the head-down tilt angle, which ensures the absence of the respiratory-based IJV excursion. Subjects and Methods: Prospective study included twenty adult patients. The IJVs scanning was carried out in 1 min after placing the patients in a horizontal position on their back and in 1 min after placing them in the head-down tilt position at 5°, 10°, 15°, and 20° tilt angles. Results: We found that collapsibility index of <9% indicating the absence of respiratory-based IJV excursion was recorded in 25% of patients in the horizontal supine position. In this case, placing the patients in the Trendelenburg position for IJV catheterization may not be indicated. In 65% of the patients, the respiratory-based excursion was not observed at 10° head-down tilt position. Only 35% of the patients required 15° head-down tilt position. Conclusions: In clinical settings, the disappearance of respiratory-based vein excursion on the ultrasound scanner screen can be considered as criteria of the head-down tilt position effectiveness.






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