In children, the complication rate of internal jugular vein (IJV) cannulation ranges from 20-56%. We undertook a prospective study to examine the effect of head rotation on the size and relative position of the IJV and the carotid artery (CA). 19 children (aged 1mo.-10 yrs.; median 5.3 yrs.), who had never undergone cannulation of the IJV underwent imaging of their IJV and CA using ultrasound (Site≈Rite II; Dymax Corp. Pittsburgh, PA) with a 7.5-MHz transducer. Imaging was done on right and left sides of the neck, both at (high) and below (low) the level of the cricoid ring, in 3 positions of head rotation: 0° (neutral), 40° (partial), 80° (full).Imaging was performed with the subjects supine in head down position. Images obtained were recorded to polaroid film prints for off-line analysis. The diameter of both the IJV and the CA and the percent overlap between the two vessels were measured from the print. Percent overlap was calculated as:[IJV overlap of CA(mm)/ CA diameter (mm)] × 100. In all head positions, the overlap between the IJV and CA was greater on the left side and greatest when the head was in full rotation (see Table). Although IJV size increased slightly with greater head rotation, this increase was not statistically significant. Subject enrollment is continuing in order to reach a final sample size of 50. Preliminary results suggest that the optimal position for IJV cannulation is on the right side with the head in a neutral position. The extent of overlap between the IJV and CA is greater on the left side both in neutral and rotated positions. This increased overlap may significantly increase the risk of complications such as carotid artery puncture.

Table 1 No caption available.
Full size table

IJV Size (mm) [mean (SD)]

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