Effect of Shoulder Traction on Size and Relative Position of Internal Jugular Vein to Carotid Artery

Samsung Medical Center

Status: Unknown

Conditions: Internal Jugular Vein Cannulation; Infants; Common Carotid Artery

Treatments: Other: caudo-ipsilateral traction of shoulder; Other: The ultrasonographic measurements without shoulder traction

Study type: Interventional

Funder types: Other

Identifiers

NCT01575184

SMC 2011-04-004-001

Details and patient eligibility

About

Internal jugular vein (IJV) catheterization is frequently performed in infants undergoing major surgery. Although it has been suggested that head rotation increases the degree of overlapping between IJV and carotid artery (CA), IJV catheterization without head rotation is extremely difficult in infants. The aim of the present study is to evaluate whether the caudo-lateral traction of the ipsilateral arm can decrease the degree of overlapping between IJV and CA in infants during head rotation.

Full description

Central venous catheterization is frequently performed in pediatric patients undergoing major surgery for fluid management and vasoactive drug therapy. Compared to subclavian vein, internal jugular vein (IJV) is generally preferred for catheterization because of the low incidence of serious complications, such as pneumothorax and hemothorax. However, especially in infants, IJV catheterization is still technically difficult because of the small size of the vein and anatomical variation.

In previous studies, ultrasound guidance and keeping in neutral head position have been recommended to increase the success rate and to decrease the overlap between carotid artery (CA) and IJV, respectively. However, devices for ultrasonography are not always available. Moreover, IJV catheterization without head rotation could be extremely difficult in infants because of relative the larger skull and the smaller neck than those of adults. Therefore, a simple method to relieve the overlap between CA and IJV would be needed.

During head rotation to the contralateral side, the cephalic part of IJV is moved to the same direction. Accordingly, the investigators thought that the counter traction of the caudal part of IJV using the caudo-lateral traction of the ipsilateral arm might relieve the overlap caused from head rotation. Therefore, the investigators evaluated the effect of the caudo-lateral traction of the ipsilateral arm on the overlap between common CA and IJV in infants.

Enrollment: 25 estimated patients

Sex: All

Ages: 1 to 12 months old

Volunteers: No Healthy Volunteers

Inclusion criteria

• infants undergoing elective surgery

Exclusion criteria

• subjects with congenital heart disease or mass in head and neck
• Subjects with anatomical malformation of great vessels
• previous central venous access via IJV

Trial design

25 participants in 2 patient groups

Shoulder traction

Experimental group

Description:

The ultrasonographic measurements with shoulder traction

Treatment:

Other: caudo-ipsilateral traction of shoulder

No traction

Active Comparator group

Description:

The ultrasonographic measurements without shoulder traction

Treatment:

Other: The ultrasonographic measurements without shoulder traction