The Effects of Positioning on the Volume/Location of the Internal Jugular Vein Using 2-Dimensional Tracked Ultrasound

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Journal of Cardiothoracic and Vascular Anesthesia





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© 2019 Objective: To investigate the effects of different positioning on the volume/location of the internal jugular vein (IJV) using 2-dimensional (2D) tracked ultrasound. Design: This was a prospective, observational study. Setting: Local research institute. Participants: Healthy volunteers. Interventions: Twenty healthy volunteers were scanned in the following 6 positions: (1) supine with head neutral, rotated 15 and 30 degrees to the left and (2) 5-, 10-, and 15-degree Trendelenburg position with head neutral. In each position the volunteer's neck was scanned using a 2D ultrasound probe tracked with a magnetic tracker. These spatially tracked 2D images were collected and reconstructed into a 3D volume of the IJV and carotid artery. This 3D ultrasound volume then was segmented to obtain a 3D surface on which measurements and calculations were performed. Measurements and Main Results: The measurements included average cross-section area (CSA), CSA along the length of IJV, and average overlap rate. CSA (mm2) in the supine and 5-, 10-, and 15-degree Trendelenburg positions were as follows: 86.7 ± 44.8, 104.3 ± 54.5, 119.1 ± 58.6, and 133.7 ± 53.3 (p < 0.0001). CSA enlarged with the increase of Trendelenburg degree. Neither Trendelenburg position nor head rotation showed a correlation with overlap rate. Conclusions: Trendelenburg position significantly increased the CSA of the IJV, thus facilitating IJV cannulation. This new 3D reconstruction method permits the creation of a 3D volume through a tracked 2D ultrasound scanning system with image acquisition and integration and may prove useful in providing the user with a “road map” of the vascular anatomy of a patient's neck or other anatomic structures.

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