The effects of trendelenburg position, positive intrathoracic pressure and head rotation on cross-sectional area of internal jugular vein

Objective: Central venous catheterization is an interventional procedure which holds an important place in daily practices of many clinicians. Although many routes can be used for this procedure, the most preferred one is internal jugular vein. Many positions and maneuveres have been tried in order to make this procedure easier and with less complications, and in our study, we evaluated the combination of these positions, maneuveres and their effects on the cross-sectional area of right internal jugular vein. Material and Methods: Thirty healthy volunteers were included in the study. By combining supine, 20° trendelenburg, manual hepatic compression, simulated Valsalva maneuveres, and 0°, 15°, 30°, 45° and maximum head rotations, the cross-sectional area of right internal jugular vein and the overlapping percentage of internal jugular vein on carotid artery were evaluated. Results: Although any significant increases in internal jugular vein cross-sectional area on head rotations of ≥ 30° were not detected in any of the groups, the overlapping percentage of internal jugular vein on carotid artery increased significantly for 30° and greater head rotation. While simulated Valsalva maneuveres and widest internal jugular vein cross-sectional area was obtained in comparing the manoeuvre, a wider internal jugular vein cross-sectional area was detected in 20° Trendelenburg position compared to the supine position. Conclusion: We observed that a wider internal jugular vein crosssectional area can be obtained more safely with <30° head rotation, valsalva maneuvere and 20° tilted trendelenburg position.