Background and Goal of Study:
The internal jugular vein (IJV) for central venous access has been associated with a 6–9% rate of carotid
artery (CA) punctures. Ultrasound studies suggest that maneuvers such as Valsalva, abdominal binder
or Trendelenburg position alone or in combination, increase the cross-sectional area of the IJV, whereas
extreme head rotation distort or collapse the vein. A higher rate of successful puncture may be more
likely when the IJV is distended.
Materials and Methods:
25 healthy volunteers were included. Exclusion being history of IJV cannulation and known allergy to
ultrasound jelly.
Patients were placed in supine position and triangles formed by two heads of sternocleidomastoid were
marked on both sides. Cross-sectional area of IJV were measured at apex, middle and base of the
triangles in supine and repeated in 15° Trendelenburg and after Valsalva in supine position. The relative
anatomical position of IJV were assessed in 0°and 30°, 45° and 90° head rotation to the contralateral
side.
Results and Discussion:
Internal jugular vein diameter: Rightside
Statistically significant difference (p value: 0.001) between Supine vs. Trendelenburg at base of the
triangle. Significant differencesSupine
position: Apex vs. Middle vs. Base (p value: 0.015)
Trendelenburg: Apex vs. Middle vs. Base (p value: 0.001)
Valsalva maneuver in supine position: Apex vs. Middle vs. Base (p value: 0.005)
Internal jugular vein diameter: Leftside
Significant differenceSupine
vs.Trendelenburgat Apex (p value: 0.004), supine vs. Trendelenburg at Middle (p value: 0.003)
and supine vs. Trendelenburg at Base of the triangle (p value: 0.001).
There is also significant difference between supine vs Valsalva maneuver at Middle (p=0.011) and Base
(p=0.014).
Position of the internal jugular vein is lateral or antero-lateral to carotid artery at 0º or 30º rotation to the
opposite side on both left and right side of the neck.
In any position of the neck and at all positions of triangle internal jugular vein is placed more anteriorly
on left side as compared to right side.
Conclusion:Diameter of internal jugular vein is more at base of the triangle as compared to apex and
middle, in both supine position and Trendelenburgposition and also Valsalva maneuver in supine
position.
Position of the internal jugular vein is lateral or antero-lateral in relation to carotid artery at 0º or 30º
rotation to the opposite side on both left and right side of the neck.

04 / Ultrasonographic assessment of cross-sectional area of internal jugular vein and relationship of internal jugular vein and carotid artery