The effect of head rotation on the relative vascular anatomy of the neck: Implications for central venous access

Raymond Merritt, Michael Hachadorian, Kristof Michaels, Eric Robert Zevallos, Kubwimana Mhayamaguru, Zuheily Closser, Charlotte Derr

Research output: Contribution to journalArticle

Abstract

Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients. Methods and Material: The anatomic relationships of the right and left IJVs and CAs were recorded with head rotation at three different positions. Patients who had the IJV in a 45 to 135 degree relationship to the CA were deemed to be in the high-risk zone for arterial puncture. Statistical Analysis: Chi square, ANOVA. Results: Right IJVs were in the high risk zone for 39.5%, 47.8% and 60.9% of cases at 0, 45 and 80 degrees of head rotation, respectively (P < 0.001). Left IJVs were in the high risk zone for 59.1%, 69.2% and 80.0% at 0, 45 and 80 degrees of head rotation, respectively. (P < 0.001). Conclusions: Head rotation should be minimized during IJV cannulation to decrease the overlap of CA by IJV. Cannulation of the left IJV appears to carry a higher degree of risk as compared to the right IJV. Placing the head in neutral position, avoiding rotation, and using ultrasound guidance are recommended to minimize complications during central venous access.

Original languageEnglish (US)
Pages (from-to)193-196
Number of pages4
JournalJournal of Emergencies, Trauma and Shock
Volume11
Issue number3
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Jugular Veins
Blood Vessels
Anatomy
Neck
Head
Carotid Arteries
Catheterization
Punctures
Internal Carotid Artery
Hospital Emergency Service
Analysis of Variance
Prospective Studies

Keywords

  • Cannulation
  • catheterization
  • central
  • ultrasound
  • venous

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The effect of head rotation on the relative vascular anatomy of the neck : Implications for central venous access. / Merritt, Raymond; Hachadorian, Michael; Michaels, Kristof; Zevallos, Eric Robert; Mhayamaguru, Kubwimana; Closser, Zuheily; Derr, Charlotte.

In: Journal of Emergencies, Trauma and Shock, Vol. 11, No. 3, 01.07.2018, p. 193-196.

Research output: Contribution to journalArticle

Merritt, Raymond ; Hachadorian, Michael ; Michaels, Kristof ; Zevallos, Eric Robert ; Mhayamaguru, Kubwimana ; Closser, Zuheily ; Derr, Charlotte. / The effect of head rotation on the relative vascular anatomy of the neck : Implications for central venous access. In: Journal of Emergencies, Trauma and Shock. 2018 ; Vol. 11, No. 3. pp. 193-196.
@article{0c2339ffbd284d9a8b7a14ff7e2f58fc,
title = "The effect of head rotation on the relative vascular anatomy of the neck: Implications for central venous access",
abstract = "Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients. Methods and Material: The anatomic relationships of the right and left IJVs and CAs were recorded with head rotation at three different positions. Patients who had the IJV in a 45 to 135 degree relationship to the CA were deemed to be in the high-risk zone for arterial puncture. Statistical Analysis: Chi square, ANOVA. Results: Right IJVs were in the high risk zone for 39.5{\%}, 47.8{\%} and 60.9{\%} of cases at 0, 45 and 80 degrees of head rotation, respectively (P < 0.001). Left IJVs were in the high risk zone for 59.1{\%}, 69.2{\%} and 80.0{\%} at 0, 45 and 80 degrees of head rotation, respectively. (P < 0.001). Conclusions: Head rotation should be minimized during IJV cannulation to decrease the overlap of CA by IJV. Cannulation of the left IJV appears to carry a higher degree of risk as compared to the right IJV. Placing the head in neutral position, avoiding rotation, and using ultrasound guidance are recommended to minimize complications during central venous access.",
keywords = "Cannulation, catheterization, central, ultrasound, venous",
author = "Raymond Merritt and Michael Hachadorian and Kristof Michaels and Zevallos, {Eric Robert} and Kubwimana Mhayamaguru and Zuheily Closser and Charlotte Derr",
year = "2018",
month = "7",
day = "1",
doi = "10.4103/JETS.JETS_5_18",
language = "English (US)",
volume = "11",
pages = "193--196",
journal = "Journal of Emergencies, Trauma and Shock",
issn = "0974-2700",
publisher = "Medknow Publications and Media Pvt. Ltd",
number = "3",

}

TY - JOUR

T1 - The effect of head rotation on the relative vascular anatomy of the neck

T2 - Implications for central venous access

AU - Merritt, Raymond

AU - Hachadorian, Michael

AU - Michaels, Kristof

AU - Zevallos, Eric Robert

AU - Mhayamaguru, Kubwimana

AU - Closser, Zuheily

AU - Derr, Charlotte

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients. Methods and Material: The anatomic relationships of the right and left IJVs and CAs were recorded with head rotation at three different positions. Patients who had the IJV in a 45 to 135 degree relationship to the CA were deemed to be in the high-risk zone for arterial puncture. Statistical Analysis: Chi square, ANOVA. Results: Right IJVs were in the high risk zone for 39.5%, 47.8% and 60.9% of cases at 0, 45 and 80 degrees of head rotation, respectively (P < 0.001). Left IJVs were in the high risk zone for 59.1%, 69.2% and 80.0% at 0, 45 and 80 degrees of head rotation, respectively. (P < 0.001). Conclusions: Head rotation should be minimized during IJV cannulation to decrease the overlap of CA by IJV. Cannulation of the left IJV appears to carry a higher degree of risk as compared to the right IJV. Placing the head in neutral position, avoiding rotation, and using ultrasound guidance are recommended to minimize complications during central venous access.

AB - Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients. Methods and Material: The anatomic relationships of the right and left IJVs and CAs were recorded with head rotation at three different positions. Patients who had the IJV in a 45 to 135 degree relationship to the CA were deemed to be in the high-risk zone for arterial puncture. Statistical Analysis: Chi square, ANOVA. Results: Right IJVs were in the high risk zone for 39.5%, 47.8% and 60.9% of cases at 0, 45 and 80 degrees of head rotation, respectively (P < 0.001). Left IJVs were in the high risk zone for 59.1%, 69.2% and 80.0% at 0, 45 and 80 degrees of head rotation, respectively. (P < 0.001). Conclusions: Head rotation should be minimized during IJV cannulation to decrease the overlap of CA by IJV. Cannulation of the left IJV appears to carry a higher degree of risk as compared to the right IJV. Placing the head in neutral position, avoiding rotation, and using ultrasound guidance are recommended to minimize complications during central venous access.

KW - Cannulation

KW - catheterization

KW - central

KW - ultrasound

KW - venous

UR - http://www.scopus.com/inward/record.url?scp=85054518406&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054518406&partnerID=8YFLogxK

U2 - 10.4103/JETS.JETS_5_18

DO - 10.4103/JETS.JETS_5_18

M3 - Article

AN - SCOPUS:85054518406

VL - 11

SP - 193

EP - 196

JO - Journal of Emergencies, Trauma and Shock

JF - Journal of Emergencies, Trauma and Shock

SN - 0974-2700

IS - 3

ER -