Trendelenburg (Head-Down tilt) and head rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety

Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head-down tilt (Trendelenburg position) and head rotation on the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross-sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0 degrees, 5 degrees, 10 degrees, and 15 degrees) and contralateral head-rotation (HR) (0 degrees, 45 degrees, and 90 degrees) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5-min rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78 cm(2) with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59 cm(2). A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5 degrees to 10 degrees TP is recommended when the patient's condition allows it, with a 45 degrees HR, without significantly displacing the IJV anterior to the CCA.