Ultrasound Study Of Right Internal Jugular Vein And Right Axillary Subclavian Vein In Different Positions

Objective1. The study used ultrasonography to observe changes in the cross-sectional area(CSA) of the right internal jugular vein during Trendelenburg6°tilt, and to examine anycumulative effects of tilt in the cross-sectional area (CSA) of the right internal jugular vein(RIJV).2. To observe changes of the CSA of the internal jugular vein and the widest diameterof the axillary-subclavain vein in seven Trendelenburg tilts, and to speculate properTrendelenburg tilt for the right internal jugular vein (RIJV) and the right axillary-subclavain vein (A-SCV) catheterization.MethodsPart One: One hundred and twenty cases patients undergoing elective surgery, ASA(American Society of Anesthesiologists, ASA) I~II, were selected. Using a portableultrasound systems with a linear6to13MHz transducer, the changes in the cross-sectionalarea (CSA) of the right internal jugular vein (RIJV) were assessed during Trendelenburg6°tilt, and the CSA of the RIJV was measured in the supine position and in1minute,2minute,3minute,4minute,5minute after Trendelenburg6°tilt.Part two: Sixty adult health volunteers were selected, using a portable ultrasoundsystems with a linear6to13MHz transducer, the cross-sectional area(CSA) of the rightinternal jugular vein (RIJV) and the widest diameter of the right axillary-subclavain vein(A-SCV) were measured and recorded during reverse Trendelenburg9°tilt, reverseTrendelenburg6°tilt, reverse Trendelenburg3°tilt, supine position, Trendelenburg3°tilt, Trendelenburg6°tilt, Trendelenburg9°tilt.ResultsPart One: In the ultrasonography study, the cross-sectional area (CSA) of the rightinternal jugular vein (RIJV) was163±38mm2in the supine position;2minutes afterTrendelenburg6°tilt, the CSA of the RIJV had increased to221±49mm2(P <0.05), anddid not change significantly in the next3minutes (P>0.05).Part Two: In the ultrasonography study, the cross-sectional area (CSA) of the rightinternal jugular vein (RIJV) was106±35mm2in the reverse Trendelenburg9°tilt,126±37mm2in the reverse Trendelenburg6°tilt,148±44mm2in the reverse Trendelenburg3°tilt,168±50mm2in the supine position,196±57mm2in the Trendelenburg3°tilt、230±68mm2in the Trendelenburg6°tilt,238±72mm2in the Trendelenburg9°tilt. Compared withthe supine position, the CSA of the RIJV had decreased significantly in the reverseTrendelenburg6°tilt and the reverse Trendelenburg9°tilt (P <0.05), there was nosignificant decrease in the CSA of the RIJV in the reverse Trendelenburg3°tilt (P>0.05).Compared with the reverse Trendelenburg6°tilt, there was no significant decrease in theCSA of the RIJV in the reverse Trendelenburg9°tilt (P>0.05). Compared with the supineposition, the CSA of the RIJV had increased significantly in the Trendelenburg6°tilt andthe Trendelenburg9°tilt (P <0.05), there was no significant increase in the CSA of theRIJV in the Trendelenburg3°tilt (P>0.05). Compared with the Trendelenburg6°tilt,there was no significant increase in the CSA of the RIJV in the Trendelenburg9°tilt (P>0.05).In the ultrasonography study, the widest diameter of the right axillary-subclavain vein(A-SCV) was8.9±1.5mm in the reverse Trendelenburg9°tilt,8.8±1.5mm in the reverseTrendelenburg6°tilt,8.9±1.4mm in the reverse Trendelenburg3°tilt,8.9±1.5mm in thesupine position,8.9±1.5mm in the Trendelenburg3°tilt,8.9±1.5mm in the Trendelenburg6°tilt,8.9±1.4mm in the Trendelenburg9°tilt. Compared with the supine position, therewas no significant change in the widest diameter of the right axillary-subclavain vein (A-SCV) in reverse Trendelenburg9°tilt, reverse Trendelenburg6°tilt, reverseTrendelenburg3°tilt、Trendelenburg3°tilt、Trendelenburg6°tilt and Trendelenburg9°tilt(P>0.05).ConclusionsPart One: The cross-sectional area (CSA) of the right internal jugular vein (RIJV)increased significantly after2minutes in Trendelenburg6°tilt, but did not changesignificantly in the next3minutes.Part Two:1. The cross-sectional area (CSA) of the right internal jugular vein (RIJV)had increased in the Trendelenburg position, and the degree of increase had certainrelationship with the Trendelenburg tilt. The cross-sectional area (CSA) of the rightinternal jugular vein (RIJV) had increased significantly in the Trendelenburg6°tilt, butthere was no further significant increase in the CSA of the RIJV in the Trendelenburg9°tilt.Therefore Trendelenburg6°tilt was recommended as the proper patient position duringthe right internal jugular vein (RIJV) catheterization.2. There was no relationship betweenthe widest diameter of the right axillary-subclavain vein (A-SCV) and the Trendelenburgposition.