Simple manoeuvre to reduce the overlap between the internal jugular vein and carotid artery in infants

• Published in: Acta anaesthesiologica Scandinavica 2014-05, Vol.58 (5), p.580-587
• Main Authors: LEE, A.-R., LEE, J.-H., LIM, H.-Y., LEE, S. M.
• Format: Article
• Language: English
• Subjects: Anesthesia, General; Carotid Arteries - anatomy & histology; Catheterization, Central Venous - methods; Elective Surgical Procedures; Female; Head; Head-Down Tilt; Humans; Infant; Jugular Veins - anatomy & histology; Male; Patient Positioning - methods; Prospective Studies; Rotation; Single-Blind Method
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12306

Background Catheterisation of the internal jugular vein (IJV) can be difficult in infants. We aimed to evaluate whether a simple manoeuvre, a slight caudo‐lateral traction of the ipsilateral arm (CLTIA), could decrease the head rotation‐induced overlap of the IJV to the carotid artery (CA) in infants. Methods Twenty‐five infants were included. The patients were placed in the 10° Trendelenburg position with a shoulder roll. On both sides of the neck, ultrasound images were obtained in a transverse orientation before and after the CLTIA at 0°, 40°, and 80° of head rotation, respectively. On each image, CA overlap was calculated as follows: CA overlap (%) = (overlap distance/CA diameter) × 100. Results The CLTIA decreased CA overlap (%) in 0°, 40°, and 80° of head rotation on the right side of the neck [14 (interquartile range, IQR 0–32) to 0 (IQR 0–14), 24 (IQR 0–46) to 0 (IQR 0–33), and 31 (IQR 12–58) to 23 (IQR 0–34); all P