J Korean Soc Emerg Med.  2012 Feb;23(1):62-67.

The Effect of Head Rotation and Leg Elevation on Skin Depth, Diameter and Relative Position of the Internal Jugular Vein, and its Implications

Affiliations
  • 1Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. psu52156@naver.com

Abstract

PURPOSE
The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA).
METHODS
A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared.
RESULTS
As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter.
CONCLUSION
Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

Keyword

Jugular veins; Carotid artery injuries; Central catheterization

MeSH Terms

Carotid Arteries
Carotid Artery Injuries
Catheterization
Catheterization, Central Venous
Catheters
Head
Jugular Veins
Leg
Neck
Punctures
Skin
Supine Position
Full Text Links
  • JKSEM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr