Quantitative measurement of the Right Internal Jugular Vein Diameter by Ultrasound Imaging in different positions

Shenbagarajan, S (2007) Quantitative measurement of the Right Internal Jugular Vein Diameter by Ultrasound Imaging in different positions. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION: The right internal jugular vein (IJV) is one of the commonest routes for central venous cannulation. The success and ease of the cannulation correlates with the diameter of the vein. It can be concluded that the larger the diameter of the IJV, the easier and quicker it is to perform cannulation. There are different ways to position the patient for the cannulation. Different positions affect the diameter of the internal jugular vein differently. One of the popular methods is the central approach described by DAILY and colleagues. This central approach is usually combined with the placement of a folded sheet under the shoulders, head turned to contralateral side completely and a finger on the carotid pulse. This conventional position and approach has been reported to result in a decrease of the diameter of the IJV. A modified position in which, there is no folded sheet under the shoulders, flexion of the neck with pillow under the head and not palpating the carotid artery, is more likely to result in increase in the diameter of the internal jugular vein. This inturn can increase the success rate of quick and first pass cannulation as well as decrease the incidence of carotid artery puncture. In this study, it is proposed to quantitatively measure the diameter of the IJV with ultrasound imaging in both the conventional position and the modified position and to determine whether there is a significant difference. As an extension of the study, the correlation between the weight, height, neck circumference and the sterno hyoid distance on the one hand and the diameter of the IJV on the other was also studied AIM OF THE STUDY: 1. To determine whether alteration in patient position affects the diameter of the internal jugular vein and the relationship of the vein to the carotid artery. 2. As an extension of the study, it was decided to asses how the height, weight, neck circumference and sterno-hyoid distance correlate with the diameter of the internal jugular vein. MATERIALS AND METHODS: A pilot study was initially performed to calculate the necessary sample size. Informed consent was obtained from twenty volunteers for the pilot study. The actual study was performed in healthy volunteers in the radiology department under the supervision of a senior radiologist and anaesthetist. After getting approval from the hospital research committee, we studied forty volunteers from our medical and para medical colleagues. All the volunteers were explained to about the procedure and informed consent was obtained. For the study, the table used was the same as that used for digital substraction angiographic procedures. All the measurements were taken with 5 degrees head down tilt and this was kept constant for all the volunteers. The materials used for the study were inch tape, weighing machine, pillow routinely used for intubation and folded sheets. The same materials were utilized for all the volunteers. The neck circumference was measured at the level of the cricoid cartilage. The sterno hyoid distance was measured from the lower border of the hyoid bone to the upper most palpable border of the sternum with neck in neutral position and the volunteer facing the observer. A B-mode sonography (Siemens, Adara) with 7-11 MHZ Transducer was used. The probe was placed horizontally at the level of the cricoid cartilage corresponding to the most frequently used point of needle insertion into the IJV. To standardize the placing of the ultrasound scanner probe, the medial wall of the carotid artery was positioned at the medial end of the screen. One person palpated the carotid artery in conventional position in all the volunteers to identify the location of the carotid artery. Two fingers were applied over this region taking care not to exert any pressure on the deeper structures. The largest internal antero-posterior (a in figure 3) and transverse (b in figure 3) diameters of the IJV on the frozen image were taken for measurements in each position. A total number of forty volunteers were included in this study. The initial twenty volunteers were placed in the conventional position first and then in the modified position. The next twenty volunteers were placed in the modified position first and then in the conventional position. CONCLUSION: 1. The antero posterior and the transverse diameters of the right internal jugular vein are significantly greater in the modified position compared to the conventional position. The larger diameter of the internal jugular vein in this modified position can lead to a greater success rate in the cannulation of the internal jugular vein. 2. Overlap of the carotid artery by the internal jugular vein is greater in the modified position compared to the conventional position. Theoritically this could result in greater incidence of carotid artery puncture if care is not taken. 3. There is no significant consistant correlation between the height, weight, neck circumference and the sterno hyoid distance with the diameter of the IJV in the population studied.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Quantitative measurement ; Right Internal Jugular Vein Diameter ; Ultrasound Imaging ; different positions.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:53
Last Modified: 30 Apr 2018 02:53
URI: http://repository-tnmgrmu.ac.in/id/eprint/7312

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