Internal Jugular Vein In Infants Research Articles

Ultrasound-guided anatomical evaluation and percutaneous cannulation of the right internal jugular vein in infants

The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.

Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study.

Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. A two-stage study was conducted. In the first observational study, infants aged ≤1year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I-A-B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants. In the first study, the data of 67 patients were analyzed. The infant's height and I-A-B distance were highly correlated with the level of the central venous catheter tip (R2 =0.763 and 0.772, respectively; all P<.01), using the regression equations 0.11× height (cm) + 0.19 and 1.02× I-A-B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants (r=.938, P=<.001). In a Bland-Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15cm, respectively. The limits of agreement were -0.19 and 0.38cm, respectively. In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.

The Effect of Passive Leg Elevation and/or Trendelenburg Position on the Cross-sectional Area of the Internal Jugular Vein in Infants and Young Children Undergoing Surgery for Congenital Heart Disease

Kim, Won Ho; Lee, Jong Hwan; Lee, Sangmin M.; Kim, Chung Su; Kang, Ryunga; Yoo, Chan Seon; Cho, Hyun Sung Author Information

The artery behind the internal jugular vein: vertebral artery or transverse cervical artery?

Dear Editor, I read, with great interest, the article by Lamperti et al. [1]. This article seems quite useful for surgeons using ultrasonography for vascular access. However, I have two questions about Fig. 1 in the article. First, the article states that the artery behind the ‘‘vein vertebral artery’’ (VA) is the thyrocervical trunk (a major branch of the subclavian artery). This assumption appears incorrect. I do not believe that the VA is a branch of thyrocervical trunk, as it originates directly from the subclavian vein. Second, I believe that the artery behind the internal jugular vein (IJV) is the transverse cervical, or possibly the inferior thyroid, artery. Did the artery disappear near the 5th or 6th vertebra? A recent report described that VAs were observed near, and behind, the IJV in 7 (13 %) of the 55 children who underwent cardiovascular surgery, under endotracheal general anesthesia [2]. However, in older patients, VAs were not observed near, and behind, the IJVs; similarly, we seldom observe the VA near, and behind, the IJVs in adults. One report described the case of an accidental transverse cervical arterial puncture behind the IJV, which led to the placement of an intra-aortic central venous catheter [3]. We have confirmed that the transverse cervical artery is positioned behind the IJV in an adult patient undergoing neck lymphadenectomy. The transverse cervical artery (one-fifth the width of the IJV) appeared from under the IJV and ran approximately 1 cm transversely and 3 cm longitudinally behind the IJV. Therefore, we believe that the artery indicated in the article by Lamperti et al. [1] must be the transverse cervical artery. It is also essential to recognize the presence of transverse cervical arteries behind the IJVs in infants [4]. A video showing IJV catheterization in an infant is available on the Kyushu Kosei Nenkin Hospital website [5]. The video provides a view of the relationships between the IJV and the subclavian artery, thyrocervical trunk, transverse cervical artery and VA. References

The Effect of Passive Leg Elevation and/or Trendelenburg Position on the Cross-Sectional Area of the Internal Jugular Vein in Infants and Young Children Undergoing Surgery for Congenital Heart Disease

In this study we evaluated the effect of passive leg elevation (LE) and Trendelenburg (T) position on the cross-sectional area (CSA) of the internal jugular vein (IJV) in infants and young children undergoing surgery for congenital heart disease. A secondary aim was to compare the CSA of the IJV between subjects with right-to-left (RL) shunt and left-to-right (LR) shunt. Ninety infants and small children from 10 days to 31 months old weighing from 1.5 to 9.7 kg were assigned to group RL (n = 48) or LR (n = 42). In both groups, the CSA, transverse, and vertical diameters of the IJV on both sides of the neck were measured using a 2-dimensional ultrasound transducer in the following positions: supine position, 15° of T position, supine position with 50° of LE, and 15° of Trendelenburg position with 50° of LE (TLE). A more than 25% increase in mean CSA of the IJV was considered clinically significant. In group LR, T, LE, and TLE significantly increased CSA of both right (at least 12.3%, 10.3%, and 18.3%, respectively, "at least" refers to the lower 95% confidence limits) and left (at least 15.8%, 15.0%, and 18.9%, respectively) IJVs, whereas only TLE increased the CSA of both IJVs significantly in group RL (at least 8.2% and 7.7% in the right and left, respectively). The increase in the CSA of the right IJV related to T and TLE was larger in group LR than in group RL (at least 12.3% vs 1.2% for T and at least 18.3% vs 8.2% for TLE, respectively). A clinically significant increase in CSA was achieved in both right and left IJVs with TLE in group LR (mean 28.6% and 26.3%, respectively). The CSA of the right IJV was larger than that of the left IJV in most (at least 69.2%) patients. Passive LE was as effective as T position to increase the CSA of the IJV, but there was no clinically significant increase in the CSA with any single maneuver. Only T position with passive LE achieved a clinically significant increase in the CSA of both IJVs in infants and young children with LR shunt, but not in the same age group with RL shunt.

Effects of skin traction on cross-sectional area of the internal jugular vein in infants and young children

Effects of skin traction on cross-sectional area of the internal jugular vein in infants and young children

Effects of Skin Traction on Cross-Sectional Area of the Internal Jugular Vein in Infants and Young Children

Internal jugular veins (IJV) are commonly used to obtain central venous access. However percutaneous cannulation of the IJVis difficult in infants and young children because of its diminutive size. The aim of this study was to evaluate the effect of skin traction on the cross-sectional area of the IJV in anaesthetised infants (younger than one year) and young children (one to six years) using ultrasound. Sixty-seven subjects undergoing general anaesthesia were studied. The cross-sectional area of the IJV was measured at the junction of the two heads of the sternocleidomastoid using ultrasound. Skin traction was performed by stretching the skin over the puncture point with pieces of surgical tape in both cephalad and caudad directions. The measurements were made after the induction of anaesthesia with patients in the supine position and with positive pressure ventilation. Skin traction increased the maximum cross-sectional area of the IJV by 39.9 +/- 29.6% in infants and by 33.8 +/- 21.9% in children (P < 0.01). This increase might facilitate easier and safer IJV cannulation in infants and children.

Effects of head rotation on the right internal jugular vein in infants and young children

We investigated the effects of head rotation on the cross-sectional area of the right internal jugular vein and its relative position to the carotid artery. Eighty-eight subjects were divided into infants and children groups. The cross-sectional area of the right internal jugular vein and the degree of the carotid artery overlap were measured at 0 degrees (neutral), 40 degrees and 80 degrees of head rotation. The cross-sectional area of the right internal jugular vein was significantly larger at 40 degrees and 80 degrees head rotation compared with the neutral position in both infants and children (p < 0.001). As the head was rotated, the percentage overlap of the carotid artery increased significantly (p < 0.001). We suggest that 40 degrees head rotation appears to be optimal for right internal jugular vein cannulation in paediatric patients.

Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants

Ultrasound guidance (USG) for internal jugular cannulation is the best solution in difficult settings where paediatric patients are involved. This is an outcome study on efficacy and complications of the USG for the internal jugular vein (IJV) cannulation in neurosurgical infants as well as an ultrasound study of anatomical findings of the IJVs in infants. A prospective study conducted in two Academic Neurosurgical hospitals. In 191 babies (body weight <15 kg), anatomical findings were studied. We performed CVC echo guided placement in 135/191 infants (weighting <10 kg). After a brief training period, both institutions adopted a common protocol and USG device. We obtained successful cannulation in all patients. Carotid puncture (1.5%) was the only main complication registered and minor complications were poor. Time required for cannulation was 12.5 +/- 5.7 min. Anatomical findings (in 191 patients) were IJV laterality in 34.6% cases, IJV antero-lateral in 59.7% and anterior in 5.7%. A linear relation was found between weight and internal jugular vein diameter even if R(2) = 0.43 and the model cannot be used to predict the exact size of the vein. In 62/135 babies weighting <10 kg, anatomical measurements were done in supine and Trendelemburg position. Trendelemburg position increases significantly (P < 0.001) IJV diameter, but not IJV depth. We considered ultrasound guidance as the first choice in infants because it can enhance IJV cannulation success, safety, and allows one to measure relationships and diameter of the IJV and optimise the central line positioning.

Anatomical features of the right internal jugular vein in infants and young children undergoing heart surgery for congenital disease: comparison between cyanotic and noncyanotic patients

It has been reported that children with cyanotic heart disease have elevated systemic levels of vascular endothelial growth factor, which may be related to the development of vessels. However, it is unknown whether the anatomical features of the internal jugular vein (IJV) differ between cyanotic and noncyanotic children. In this study, we compared anatomical information about the IJV of these two groups of patients. We measured the distance between the right IJV and the right carotid artery (distance), the diameter of the IJV (diameter), and the depth of the IJV from the skin (depth), using an ultrasound device, in 100 children (0-34 months) undergoing heart surgery for congenital disease. First, we evaluated the relationship of these measurement values with patient demographic data (age, height, and body weight). Next, we evaluated the effect of the 15 degrees Trendelenburg position on these measurement values. There were 62 cyanotic and 38 noncyanotic patients. Distance and diameter, but not depth, were well correlated with the demographic data in both patient groups. Diameter in cyanotic patients was highly correlated with the demographic data. Clinically significant changes in the measurement values were not observed in the 15 degrees Trendelenburg position compared with the horizontal position in either patient group. The anatomical features of the right IJV in infants and young children with congenital heart disease were not different in cyanotic and noncyanotic patients, except for the relationship between diameter and the demographic data. In the small patients examined in our study (72% of them were infants), the diameter of the IJV was not sufficiently enlarged by the Trendelenburg position, regardless of whether the patients were cyanotic or noncyanotic.

Central venous catheterization in infants and children – small caliber audio‐Doppler probe versus ultrasound scanner

Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. In children (>12 months), both methods were equally efficient. But in infants (<12 months), success rate at the first attempt using audio-Doppler was worse than the rate using an ultrasound scanner and there were more complications when audio-Doppler was used. We conclude that application of both the audio-Doppler and the ultrasound scanner is useful in children over 1 year of age for access to the internal jugular vein. However, in infants and neonates, the ultrasound scanner would be more useful than the audio-Doppler.

A randomized‐controlled study of ultrasound prelocation vs anatomical landmark‐guided cannulation of the internal jugular vein in infants and children

A specifically designed ultrasound scanner may be helpful in percutaneous cannulation of the internal jugular vein in pediatric patients. We report a new two-dimensional (2D) ultrasound prelocation (UL) technique using a transesophageal echocardiography (TEE) intraoperative probe instead of the portable scanner, and have compared the new technique with conventional anatomical landmark method (AL) for central venous catheterization in infants and children. Sixty-two infants (body weight <12 kg) undergoing elective surgery for congenital heart disease were randomized into two groups. In the AL group, the landmark for cannulation was the palpation of the common carotid pulsation or the sternocleidomastoid triangle. In the UL group, the central vein was located by 2D ultrasonic imaging using a TEE intraoperative probe for HP SONOS 4500. The number of cannulation attempts, success rate, and complication rate were recorded. For the UL and AL groups, the cannulation success rate was 100% and 80% (P < 0.05), the incidence of arterial puncture was 3.1% and 26.7% (P < 0.025), and the number of attempts was 1.57 +/- 1.04 and 2.55 +/- 1.76 (P < 0.001), respectively. Two-dimensional ultrasound prelocated central venous catheterization in infants and children is convenient and can markedly increase cannulation success rate and reduce the incidence of complications.

Ultrasonic locating devices for central venous cannulation: meta-analysis

Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation.Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature.Design...

The effects of the simulated Valsalva maneuver, liver compression, and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children.

We calculated the effects of the simulated Valsalva (V), liver (L) compression, and Trendelenburg (T) position on the cross-sectional area (CSA) of the right internal jugular vein by using planimetry (Aloka ultrasound machine) in 84 infants and young children. Eight combinations of positions and interventions were studied for each patient, with the patient supine, in the T position, during the simulated V maneuver, with L compression and a combination of maneuvers. Data were analyzed by using Friedman's chi(2) test and Wilcoxon's signed rank test. An increase of >25% in the CSA of the internal jugular vein was considered significant. In infants, the maximal mean increase achieved with the combination of all 3 maneuvers was only 17.4% +/- 16.1%. As a single maneuver, the simulated V was the most effective (11.6% +/- 11.5%). In children, the combination of all 3 maneuvers performed simultaneously produced a mean 65.9% (SD +/- 44.7%) increase in the CSA, which was larger than the increase by all other maneuvers alone or in a single combination (Friedman's test, P < 0.001 and Wilcoxon's test, P < 0.002). As a single maneuver, V produced the most increase (40.4% +/- 32.2%) compared with L compression (14.3% +/- 18.9%) or T position (24.3% +/- 27.1%). The combinations of simulated Valsalva, liver compression, and Trendelenburg maneuvers produce the maximal mean increase in the size of the internal jugular vein in infants and young children, with the Valsalva maneuver being the most effective single maneuver. This increase is significant in young children, but negligible in infants.

The Effects of the Simulated Valsalva Maneuver, Liver Compression, and/or Trendelenburg Position on the Cross-Sectional Area of the Internal Jugular Vein in Infants and Young Children

We calculated the effects of the simulated Valsalva (V), liver (L) compression, and Trendelenburg (T) position on the cross-sectional area (CSA) of the right internal jugular vein by using planimetry (Aloka® ultrasound machine) in 84 infants and young children. Eight combinations of positions and interventions were studied for each patient, with the patient supine, in the T position, during the simulated V maneuver, with L compression and a combination of maneuvers. Data were analyzed by using Friedman’s χ2 test and Wilcoxon’s signed rank test. An increase of >25% in the CSA of the internal jugular vein was considered significant. In infants, the maximal mean increase achieved with the combination of all 3 maneuvers was only 17.4% ± 16.1%. As a single maneuver, the simulated V was the most effective (11.6% ± 11.5%). In children, the combination of all 3 maneuvers performed simultaneously produced a mean 65.9% (sd ± 44.7%) increase in the CSA, which was larger than the increase by all other maneuvers alone or in a single combination (Friedman’s test, P < 0.001 and Wilcoxon’s test, P < 0.002). As a single maneuver, V produced the most increase (40.4% ± 32.2%) compared with L compression (14.3% ± 18.9%) or T position (24.3% ± 27.1%).

Ultrasonography for Cannulation of Internal Jugular Vein in Infants - A Superior Technique? • 237

Ultrasonography for Cannulation of Internal Jugular Vein in Infants - A Superior Technique? • 237

Percutaneous cannulation of the internal jugular vein in infants and children: M. M. Krausz, Y. Berlatzky, A. Ayalon, H. Freund, and M. Schiller. Surg Gynecol Obstet 148:591–594, (April), 1979

Percutaneous cannulation of the internal jugular vein in infants and children: M. M. Krausz, Y. Berlatzky, A. Ayalon, H. Freund, and M. Schiller. Surg Gynecol Obstet 148:591–594, (April), 1979

Percutaneous catheterization of the internal jugular vein in infants and children

Two methods are described for percutaneous catheterization of the internal jugular vein in children. The technique can be used even in premature babies. No serious complications were observed from the catherization in 100 cases.

Techniques and Instruments: Percutaneous catheterization of the internal jugular vein in infants and children

Techniques and Instruments: Percutaneous catheterization of the internal jugular vein in infants and children

Percutaneous catheterization of the internal jugular vein in infants and children.

Percutaneous catheterization of the internal jugular vein in infants and children.