Abstract
Right internal jugular vein (RIJV) catheterisation is a common procedure in patients undergoing surgery. We aimed to compare diameters and the cross-sectional area (CSA) of the RIJV when the head is in a neutral or 30-degree rotated position during mechanical ventilation in various modes and spontaneous ventilation. Thirty patients undergoing surgery were included in the study. In each patient, still ultrasound images of the vena jugularis interna were taken with the head in a neutral position and with the neck rotated 30 degrees to the left, first under spontaneous ventilation (group S), then after the induction of anaesthesia under volume-controlled ventilation (group V) and under pressure-controlled ventilation (group P). The six still images were evaluated in terms of transverse and anteroposterior diameters and CSA. Diameters in the neutral and lateral positions in group S were significantly smaller than in group P and group V (neutral transverse p = 0.01, anteroposterior p = 0.041, rotated transverse p = 0.01, anteroposterior p = 0.03). The CSAs of the RIJV in the neutral and lateral positions were significantly larger in group P and group V than Group S (lateral CSA p = 0.001, neutral CSA p = 0.002). CSA increased significantly only in group P when the head was rotated 30 degrees laterally (p = 0.002). We conclude that both pressure-controlled and volume-controlled mechanical ventilation have similar effects on the CSA and diameters of the RIJV. Positioning of the head with a 30-degree rotation laterally has different effects on CSA depending on the ventilation mode used. A neutral position should be preferred with spontaneous ventilation whereas 30 degree rotation should be preferred in patients under pressure-controlled and volume-controlled ventilation.
Highlights
Central venous line placement is a common procedure used by anaesthetists in patients undergoing major surgery or in intensive care units [1, 2]
The cross-sectional area (CSA) of the Right internal jugular vein (RIJV) in the neutral and lateral positions were significantly larger in group P and group V than Group S
In terms of anteroposterior diameters in the 30 degree rotated to lateral position of the head, the diameter measured in group S was significantly smaller than those in group P (p = 0.006) and group V (p = 0.04)
Summary
Central venous line placement is a common procedure used by anaesthetists in patients undergoing major surgery or in intensive care units [1, 2]. The literature recommends the use of ultrasound, the blind surface anatomic landmark guided technique still predominates in clinical practice [2, 4]. Using this method can lead to failure of puncture in 10% to 31% of attempts and arterial puncture in 5% to 9% of patients on the first attempt; in total, one or more complications in 5% to 40% of all patients who have a catheterisation intervention [2, 5, 6]. The aim of our study was to evaluate the changes in CSA and diameters of the RIJV during two different modes of mechanical ventilation (pressure-controlled ventilation [PCV] and volume-controlled ventilation [VCV]) and spontaneous ventilation with the head in a neutral position and a 30-degree rotated lateral position by use of ultrasonography, and to determine the ventilation mode that is most suitable for catheterisation
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