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Re: Manoeuvres affecting central venous cannulation

Dear Editor,

Clenaghan et al [1] have demonstrated that Trendelenberg tilt increases the diameter of the internal jugular vein (IJV) in healthy volunteers. This confirms the results of previous studies.[2]

While the benefits of Trendelenburg tilt are well known, the negative effects of other commonly performed manoeuvres are less well appreciated. Gentle palpation of the carotid artery and neck extension cause significant decreases in IJV size.[2] Textbooks describe the IJV as lying lateral to the carotid artery but ultrasound studies show that it overlies the carotid artery to some degree in 54% of subjects. The degree of overlap increases with head rotation [3], which may increase the risk of carotid artery puncture, especially if the needle passes through the posterior wall of the IJV.

Carotid artery palpation, neck extension and head rotation are often used during IJV cannulation. These manoeuvres decrease the target size and potentially increase the risk of failure or complications, and should be avoided during IJV cannulation using a landmark technique.

References

1. Clenaghan S, McLaughlin RE, Martyn C et al. Relationship between Trendelenberg tilt and internal jugular vein diameter. Emerg Med J 2005;22:867-8.

2. Armstrong PJ, Sutherland R, Scott DHT. The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 1994;38:229-31.