Ultrasound Assessment of Internal Jugular Vein for Cannulation and Venous Pressure Prediction

Ultrasound Guidance for Internal Jugular Vein Cannulation: Can Doppler Ultrasound Predict Jugular Venous Pressure Changes by Assessment of Internal Jugular Vein Diameter and Collapsibility?

This prospective observational study aims to evaluate the diagnostic utility of vascular ultrasound for internal jugular vein (IJV) assessment in adult patients undergoing clinically indicated IJV cannulation.

Traditionally, bedside clinical assessment of jugular venous pressure (JVP) is challenging and frequently imprecise in critically ill or obese individuals. This study investigates whether non-invasive ultrasound parameters, specifically IJV diameter, collapsibility index, and Doppler flow patterns, can reliably estimate central venous pressure (CVP) and identify elevated JVP.

Participants admitted to the Intensive Care Unit, Emergency Department, or Operating Theatres who require right IJV catheterization will receive a standardized pre-procedural vascular ultrasound evaluation in a supine position (0-30° head elevation) prior to routine, ultrasound-guided cannulation. Ultrasound measurements will then be compared to direct central venous pressure readings to assess diagnostic accuracy and correlation.

Inclusion Criteria:

• Adult patients aged 18 years or older.
• Patients admitted to the Intensive Care Unit (ICU), Emergency Department, or Operating Theatres who require internal jugular vein (IJV) cannulation for clinical indications.
• Patients in whom ultrasound-guided right internal jugular vein cannulation is planned.
• Patients who are hemodynamically stable enough to undergo ultrasound examination before cannulation.
• Patients able to undergo vascular ultrasound examination in the supine position (0-30° head elevation according to the study protocol).
• Patients in whom complete ultrasound assessment of the internal jugular vein can be performed (including maximum diameter, minimum diameter, cross-sectional area, and collapsibility/distensibility index).
• Patients with a clinically indicated assessment of central venous pressure (CVP) or jugular venous pressure (JVP) allowing comparison with ultrasound measurements.
• Patients providing written informed consent, or consent obtained from a legally authorized representative when applicable.

Exclusion Criteria:

• Patients younger than 18 years of age.
• Previous surgery, radiotherapy, or significant trauma involving the neck.
• Known thrombosis, stenosis, or congenital anomalies of the internal jugular vein.
• Local infection, cellulitis, burn, or hematoma at the intended cannulation site.
• Large neck masses, thyroid enlargement, or cervical pathology causing distortion of neck anatomy.
• Severe coagulopathy or uncontrolled bleeding disorders contraindicating internal jugular vein cannulation.
• Patients with cervical spine instability or those in whom proper positioning for ultrasound examination is not possible.
• Inadequate ultrasound visualization of the internal jugular vein.
• Severe tricuspid valve disease or conditions causing marked alterations in central venous hemodynamics that interfere with accurate interpretation of IJV measurements.
• Refusal of the patient or legally authorized representative to provide informed consent.