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VOLUME 21 , ISSUE 3 ( 2017 ) > List of Articles

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Using Ultrasonography to Determine Optimal Head-down Tilt Position Angle in Patients before Catheterization of the Internal Jugular Vein

Anton A. Kasatkin, Aleksandr L. Urakov, Anna R. Nigmatullina

Keywords : Internal jugular vein, respiratory-based internal jugular vein excursion, ultrasound scanning

Citation Information : Kasatkin AA, Urakov AL, Nigmatullina AR. Using Ultrasonography to Determine Optimal Head-down Tilt Position Angle in Patients before Catheterization of the Internal Jugular Vein. Indian J Crit Care Med 2017; 21 (3):160-162.

DOI: 10.4103/ijccm.IJCCM_299_16

License: CC BY-ND 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

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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  1. Armstrong PJ, Sutherland R, Scott DH. The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 1994;38:229-31.
  2. American Society of Anesthesiologists Task Force on Central Venous Access, Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, et al. Practice guidelines for central venous access: A report by the American Society of Anesthesiologists Task force on central venous access. Anesthesiology 2012;116:539-73.
  3. Onal O, Apiliogullari S, Nayman A, Saltali A, Yilmaz H, Celik JB. The effectiveness of trendelenburg positioning on the cross-sectional area of the right internal jugular vein in obese patients. Pak J Med Sci 2015;31:770-4.
  4. Kasatkin AA, Urakov AL, Nigmatullina AR. Inventors. Method for Internal Jugular Vein Catheterization. Russian Federation Patent RU 2573337; 20 January, 2016.
  5. Kasatkin AA, Urakov AL, Nigmatullina AR. Venous catheterization with ultrasound navigation. AIP Conf Proc 2015;1688:060010.
  6. Gok F, Sarkilar G, Kilicaslan A, Yosunkaya A, Uzun ST. Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients. Int J Clin Exp Med 2015;8:19037-43.
  7. Suarez T, Baerwald JP, Kraus C. Central venous access: The effects of approach, position, and head rotation on internal jugular vein cross-sectional area. Anesth Analg 2002;95:1519-24.
  8. Bellazzini MA, Rankin PM, Gangnon RE, Bjoernsen LP. Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility. Am J Emerg Med 2009;27:454-9.
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