Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug;56(8):468-71.
doi: 10.11622/smedj.2015020.

The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children

Gamze Naime Dincyurek  1 , Elif Basagan Mogol  1 , Gurkan Turker  1 , Belgin Yavascaoglu  1 , Alp Gurbet  1 , Fatma Nur Kaya  1 , Bachri Ramadan Moustafa  1 , Tolga Yazici  1
Affiliations

The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children

Gamze Naime Dincyurek et al. Singapore Med J. 2015 Aug.

Abstract

Introduction: We compared the effects of various surgical positions, with and without the Valsalva manoeuvre, on the diameter of the right internal jugular vein (RIJV).

Methods: We recruited 100 American Society of Anesthesiologists physical status class I patients aged 2-12 years. The patients' heart rate, blood pressure, peripheral oxygen saturation and end-tidal CO2 pressure were monitored. Induction of anaesthesia was done using 1% propofol 10 mg/mL and fentanyl 2 µg/kg, while maintenance was achieved with 2% sevoflurane in a mixture of 50/50 oxygen and air (administered via a laryngeal mask airway). The RIJV diameter was measured using ultrasonography when the patient was in the supine position. Thereafter, it was measured when the patient was in the supine position + Valsalva, followed by the Trendelenburg, Trendelenburg + Valsalva, reverse Trendelenburg, and reverse Trendelenburg + Valsalva positions. A 15° depression or elevation was applied for the Trendelenburg position, and an airway pressure of 20 cmH2O was applied in the Valsalva manoeuvre. During ultrasonography, the patient's head was tilted 20° to the left.

Results: When compared to the mean RIJV diameter in the supine position, the mean RIJV diameter was significantly greater in all positions (p < 0.001) except for the reverse Trendelenburg position. The greatest increase in diameter was observed in the Trendelenburg position with the Valsalva manoeuvre (p < 0.001).

Conclusion: In paediatric patients, the application of the Trendelenburg position with the Valsalva manoeuvre gave the greatest increase in RIJV diameter. The reverse Trendelenburg position had no significant effect on RIJV diameter.

Keywords: Trendelenburg; Valsalva; catheterisation; reverse Trendelenburg; ultrasonography.

PubMed Disclaimer

References

    1. Mark JB, Slaughter TF. Cardiovascular monitoring. In: Miller RD, editor. Anesthesia. 6th ed. I. Philadelphia: Churchill Livingstone; 2004. pp. 1265–363.
    1. Kim JH, Kim CS, Bahk JH, et al. The optimal depth of central venous catheter for infants less than 5 kg. Anesth Analg. 2005;101:1301–3. - PubMed
    1. Hilty WM, Hudson PA, Levitt MA, Hall JB. Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation. Ann Emerg Med. 1997;29:331–6. - PubMed
    1. Legler D, Nugent M. Doppler localization of the internal jugular vein facilitates central venous cannulation. Anesthesiology. 1984;60:481–2. - PubMed
    1. Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med. 2005;46:456–61. - PubMed

LinkOut - more resources