Original Contribution
Internal jugular veins must be measured before catheterization

https://doi.org/10.1016/j.jclinane.2014.09.010Get rights and content

Highlights

  • The cross-sectional area (CSA) of the right and left internal jugular vein (IJV) was measured in supine position.

  • The CSA of IJVs varies widely.

  • The CSA of the IJV on the right side is significantly greater than on the left side.

  • A “small” (CSA ≤ 0.4 cm2) IJV may occur on both sides.

Abstract

Study objective

The study objective is to determine the cross-sectional area (CSA) of the right and left internal jugular vein (IJV) in supine position in healthy subjects.

Design

This is a prospective, nonrandomized study.

Setting

The setting is a university hospital.

Patients

The patients are 185 consenting healthy subjects.

Interventions

B-mode ultrasonography examinations of the right and left IJV were performed with the use of a linear 14-MHz transducer at the level of the cricoid cartilage. The CSA of the examined vessels was measured in a supine position.

Measurements and main results

The CSA on both sides differed by up to 850%. There were no statistically significant differences between CSA of IJVs in men and women. The CSA of the IJV on the right side was significantly greater than on the left side. The right IJV was more often classified as the “dominant” vessel (CSA being more than twice as large as the opposite side). A “small” vessel (CSA ≤ 0.4 cm2) was found in 54 cases (14.6%). In 9 subjects (4.9%), they were detected bilaterally.

Conclusion

The CSA of IJVs varies widely. Although the CSA was found to be often greater on the right than on the left side, a “small” vessel may occur on both sides.

Introduction

Internal jugular vein (IJV) catheterization is an essential and commonly performed procedure in the management of critically ill patients. It allows for invasive hemodynamic monitoring with pulmonary artery catheter, total parenteral nutrition, drug delivery, temporary cardiac pacing, venous blood sampling, and renal replacement therapy. However, procedure failure and complications after catheter placement are not rare [1], [2]. These may be the result of the small cross-sectional area (CSA) of IJVs, which are difficult, sometimes even impossible to palpate transcutaneously and insert a catheter. Small vessels are also more prone to endothelial damage during cannulation and to the following thrombosis than large ones [3]. Unfortunately, there is a shortage of data about morphologic parameters of IJVs in healthy subjects.

The aim of the study was to evaluate the CSA of IJVs in healthy subjects.

Section snippets

Materials and methods

The examined group consisted of 185 healthy White subjects: 101 women and 84 men, aged 18-89 years (mean 46.2 ± 20.9). Subjects for the study were volunteers recruited from students of the medical center, hospital staff, and their relatives. The study was approved by the Commission of Bioethics at Bialystok Medical University, and each subject gave informed consent. All ultrasonography examinations were performed in gray-scale by radiologist with 6 years' experience in ultrasonography (DC)

Results

The CSA of the IJVs varied widely in the entire examined group as well as in the separate sexes (Table). There were no statistically significant differences between sex groups. The CSA of the IJV on the right side was significantly greater than on the left side. The IJV on the right side was also more often classified as the “dominant” vessel (n = 36; 54%) compared with the left side (n = 31; 46%). The asymmetry between vessels on both sides differed by up to 850% when comparing right-to-left

Discussion

The CSA of IJVs in healthy subjects in the supine position is significantly greater on the right side than on the left, with the right being more often “dominant.” Similar trends were found by other authors. Lobato et al [4] reported greater CSAs of right IJVs in 80% and significantly smaller CSAs (defined as a CSA < 50% compared with the opposite vessel) of left IJVs in 34% of healthy subjects. Lichtenstein et al [5] also found that right IJVs were more commonly “dominant” than left IJVs in a

References (8)

There are more references available in the full text version of this article.

Cited by (11)

  • Split internal jugular vein: surgical and radiological implications

    2017, British Journal of Oral and Maxillofacial Surgery
  • Comparison of the diameter, cross-sectional area, and position of the left and right internal jugular vein and carotid artery in adults using ultrasound

    2016, Journal of Clinical Anesthesia
    Citation Excerpt :

    In addition, the RIJV was less likely to be in an anterior position to its corresponding CA in comparison with the LIJV. Previous investigations have examined neck anatomy relevant to IJV (IJV) cannulation in supine healthy patients with neutral head position [1,17–23]. Our study found that the RIJV was dominant in 72% of patients and had a larger diameter and CSA compared with the LIJV (Table 2).

View all citing articles on Scopus
View full text