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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Shoulder traction | Experimental | The ultrasonographic measurements with shoulder traction |
|
| No traction | Active Comparator | The ultrasonographic measurements without shoulder traction |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| caudo-ipsilateral traction of shoulder | Other | After the head rotation (0, 40, 80 degrees) to the contralateral side from the ultrasound measuring site, the slight caudo-ipsilateral traction of shoulder will be applied without changing the degree of the head rotation. |
| Measure | Description | Time Frame |
|---|---|---|
| Carotid artery (CA) overlap (%) | CA overlap = (overlap distance between CA and internal jugular vein)/CA diameter) × 100 measured by ultrasound image | 10 seconds after head positioning |
| Measure | Description | Time Frame |
|---|---|---|
| IJV (internal jugular vein) safety portion (%) | IJV safety portion = (1-ovelap distance/IJV diameter) × 100 measured by ultrasound image | 10 seconds after head positioning |
| overlap distance (mm) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jong Hwan Lee, MD, PhD | Contact | 82-2-3410-1928 | jonghwan75.lee@samsung.com | |
| Ae Ryoung Lee, MD | Contact | 82-2-3410-1929 | nanrong.lee@samsung.com |
| Name | Affiliation | Role |
|---|---|---|
| Jong Hwan Lee, MD, PhD | Samsung Medical Center | Principal Investigator |
| Won Ho Kim, MD | Samsung Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Samsung Medical Center | Recruiting | Seoul | 135-710 | South Korea |
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| The ultrasonographic measurements without shoulder traction | Other | After the head rotation (0, 40, 80 degrees) to the contralateral side from the ultrasound measuring site, the no traction of shoulder will be applied. |
|
overlap distance (mm) of carotid artery and internal jugular vein measured by ultrasound image
| 10 seconds after head position |
| jugular to carotid distance (mm) | the distance (mm) between lateral border of carotid artery and center of internal jugula vein measured by ultrasound image | 10 seconds after head position |
| CA diameter (mm) | carotid artery diameter (mm) measured by ultrasound image | 10 seconds after head positioning |
| IJV diameter (mm) | internal jugualr vein diameter (mm) measured by ultrasound image | 10 seconds after head positioning |