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Neutral versus 45 degree rotated position of head for internal jugular vein cannulation: A comparative study based on ultrasonography

Siddharth Parmar, Harshil Mehta.

Background: Most of the methods do not specify its optimal degree of head rotation during central venous catheterization.

Aims & Objective: To compare neutral versus 45 degree rotated position of head for internal jugular vein (IJV) cannulation based on ultrasonography.

Material and Methods: This prospective, randomized study was conducted in a teaching and tertiary care hospital. Randomly selected 100 healthy volunteers were placed supine with 15º trendelenberg position. Head of the volunteer was kept neutral in group N (100 volunteers) and 45º rotated in group R (100 volunteers). 7.5 M Hz linear array probe of a portable ultrasound was placed perpendicular to the apex of triangle formed by two heads of sternocleidomastoid muscle and clavicle. We simulated a line as a needle insertion on ultrasound screen passing the mid-point of the IJV. A “hit” was defined as the intersection of the inner lumen of carotid artery (CA) by simulated line. The observations were recorded for both sides of neck for each group. Student’s t test was applied for quantitative data and Fisher exact test for qualitative data. P value < 0.05 was taken as significant.

Results: The frequency of ‘Hit’ was less in group N than R (right side: 5% versus 15%, p=0.0317; left side: 15% versus 28% p=0.0381). Total frequency of ‘Hit’ was less in right side than left side for both groups (p0.05). The distance of IJV from skin was more in group N than R (right side: 10.29±1.88 versus 9.75±1.88, p=0.0436; left side: 10.75±1.87 versus 10.21±1.86, p=0.0416).

Conclusion: A neutral position was safer than 45 º neck rotation during IJV cannulation with regard to CA puncture

Key words: Carotid Puncture; Central Venous Catheterization; Jugular Vein; Ultrasonography

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