Keywords : Internal jugular vein
ULTRASOUND ASSESSMENT OF RIGHT INTERNAL JUGULAR VEIN DIMENSIONS FOLLOWING PASSIVE LEGS ELEVATION VERSUS HEPATIC COMPRESSION
Basrah Journal of Surgery,
2020, Volume 26, Issue 1, Pages 51-60
Central venous catheterization has an essential role in the management of patients who are critically ill, and patients who have special operative interventions. In general, the bigger the vein cross sectional area and diameter the easier the catheterization will be. There are different maneuvers to increase internal jugular vein caliber. These include; passive legs elevation, hepatic or abdominal compression, Trendelenburg position, Valsalva maneuver, and positive end-expiratory pressure.
The objective of the study is to evaluate the effect of passive legs elevation and hepatic compression on the diameter and the cross-sectional area of the right internal jugular vein.
This prospective study included 80 adult patients ASA class I and II. Patients who had any contraindication to the passive legs elevation or hepatic compression, or those with disruption of the local neck anatomy; were excluded from the study. Patients were evaluated for their right internal jugular vein cross-sectional area and diameter by the use of linear high frequency two-dimensional ultrasound. Each patient has three stages of measurement; supine, Passive legs elevation at (30o-45o) for one minute, and hepatic compression.
Of the 80 patients, 70% were males, the age range was (19–55 years) with a mean of (37.75±12.16) years, and the majority were overweight. The maximum diameter was achieved during hepatic compression with a stepwise statistically significant increase of about (0.44±0.27 cm) from the baseline in supine position, when compared to only (0.26±0.21 cm) during passive legs elevation. The cross-sectional area is significantly and maximally increased from the baseline of (0.93 ± 0.59 cm2), during hepatic compression. The increase in the diameter and the cross sectional area was more significant in males irrespective to age and weight.
In conclusion, Hepatic compression is significantly superior to the passive legs elevation in achieving more right internal jugular vein diameter and cross-sectional area.