Head Rotation During Internal Jugular Vein Cannulation and the Risk of Carotid Artery Puncture

  title={Head Rotation During Internal Jugular Vein Cannulation and the Risk of Carotid Artery Puncture},
  author={Cheri A. Sulek and Nikolaus Gravenstein and Robert H. Blackshear and Lee Weiss},
  journal={Anesthesia \& Analgesia},
We undertook a prospective laboratory study to examine the effect of head position on the relative positions of the carotid artery and the internal jugular vein (IJV).Volunteers (n = 12) from departmental staff, 18-60 yr of age, who had never undergone cannulation of the IJV underwent imaging of their IJV and carotid artery. With the subject in a 15 degrees Trendelenburg position, two-dimensional ultrasound images of the IJV and the carotid artery were obtained on the left and right sides of… 
The influence of head rotation on the anatomical relationship of the right internal jugular vein and the carotid artery
Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV, and to decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJv catheterization.
Anatomical relationship between the common carotid artery and the internal jugular vein during head rotation
Investigation of the anatomical relationship between the common carotid artery and internal jugular vein during head rotation for the effective performance of percutaneous transjugular procedures concluded that head rotation should be kept to <45° at 2 cm above the clavicle and <30° at 4  cm above theClavicle to decrease the risk of accidental puncture of the commonCarotid arteries during internal jugul vein puncture.
The Examination of Internal Jugular Vein and Carotid Artery in Trendelenburg Position with Head Rotation; A Prospective, Randomized Study
In 18.5% of patients positioned in the Trendelenburg position, with their head turned to the left 30o, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique.
Ultrasound analysis of the relationship between right internal jugular vein and common carotid artery in the left head-rotation and head-flexion position
Excessive left rotation should be avoided to minimize the probability of unintentional CCA puncture during IJV cannulation, and when 30° left rotation is not feasible, the head-flexion position should be utilized.
The Optimal Angle of Head Rotation for Internal Jugular Cannulation as Determined by Ultrasound Evaluation.
The authors found the internal jugular vein becomes more vertically separated from the carotid artery at more extreme angles of contralateral head rotation.
Relationship of the internal jugular vein to the common carotid artery: implications for ultrasound-guided vascular access
Ultrasound images used for IJV access usually depict the vein as being anterior to the CCA and only to a minor extent in the lateral position, which is important for needle processing in order to avoid accidental arterial puncture and to identify atypical positions of the IJV.
Quantitative measurement of the Right Internal Jugular Vein Diameter by Ultrasound Imaging in different positions
It is proposed to quantitatively measure the diameter of the IJV with ultrasound imaging in both the conventional position and the modified position to determine whether there is a significant difference.
The neutral head position with Valsalva's maneuver as a safe and reliable method for IJV cannulation is advocated.
Internal Jugular Vein and Carotid Artery Anatomic Relation as Determined by Ultrasonography
The authors' purpose in this study was to examine, using ultrasound, the anatomic relation of the IJV and CA as viewed from the perspective of a cannulating needle, and found that patients older than 60 yr were more likely to have this anatomy than patients younger than60 yr.


Neutral head position for placement of internal jugular vein catheters
This technique is proposed as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma and was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability.
Anatomical variations of internal jugular vein location: Impact on central venous access
These findings suggest that anatomical variation may partly account for the inability to cannulate the internal jugular vein in certain patients and suggest that ultrasound examination quickly establishes the position of the internaljugular vein and may allow for easy and rapid access.
A Controlled Comparison of Techniques for Locating the Internal Jugular Vein Using Ultrasonography
Fifteen techniques for localization of the internal jugular vein were evaluated in each of 25 subjects using ultrasonography to simulate actual cannulation and it was concluded that no one technique is clearly superior to the others.
Ultrasonographic anatomy of the internal jugular vein relevant to percutaneous cannulation
Ultrasonographic scans of the right side of the neck of 16 subjects were done in order to determine the anatomical features relevant to efficient cannulation of the internal jugular vein. The cross
Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients.
Determining the course of the internal jugular vein with the scanner and then marking it on the overlying skin reduced both the time and number of needle insertions required to aspirate jugular venous blood and increased the chance of a complication-free cannulation.
Percutaneous Cervical Central Venous Line Placement: A Comparison of the Internal and External Jugular Vein Routes
It is concluded that IJV cannulation is a more reliable means of percutaneous central venous line placement but is associated with a significant incidence of complications which can be reduced if a technique employing a scout needle and guide-wire is used.
Ultrasound‐facilitated central venous cannulation
Ultrasound guidance reduces both the duration of time and the number of punctures required to cannulate the internal jugular vein, and the Seldinger technique appears safer for catheterization of the internaljugular vein.
[Percutaneous catheterization of internal jugular vein].
  • C. Wang, C. Chien, Y. P. Lin
  • Medicine
    Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui
  • 1992
Percutaneous catheterization of internal jugular vein has been recognized as a valuable procedure during special conditions which need either a central venous pressure monitoring or a route for
Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial.
Intensivists can increase successful internal jugular vein cannulation using ultrasound guidance and two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.
The ‘SiteRite’ ultrasound machine—an aid to internal jugular vein cannulation
The ‘SiteRite’ ultrasound imaging system was easy to use and gave good quality images, increased the speed of cannulation, decreased the number of attempts to locate the internal jugular vein and reduced the failure rate, although it had no effect on the incidence of carotid artery puncture.