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Comparative Study
. 2017 Jul-Aug;37(4):308-312.
doi: 10.5144/0256-4947.2017.308.

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter

Pelin Karaaslan  1 , Banu Vural Gokay, Muhammet Ahmet Karakaya, Kamil Darcin, Afak Durur Karakaya, Tugrul Ormeci, Emine Arzu Kose
Affiliations
Comparative Study

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter

Pelin Karaaslan et al. Ann Saudi Med. 2017 Jul-Aug.

Abstract

Background: Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver.

Objective: Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique.

Design: Prospective clinical study.

Setting: University hospital.

Subjects and methods: Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated.

Main outcome measure(s): Hemodynamic measurements and RIJV dimensions.

Results: In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P < .001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and < .001 for cross-sectional area and diameter, respectively).

Conclusion: Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position.

Limitations: No catheterization and study limited to healthy volunteers.

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Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) RIJV measurement in the Trendelenburg position; (B) RIJV measurement with upper-limb tourniquet inflated.
Figure 2
Figure 2
Mean (SD, range) diastolic (left) and systolic (right) blood pressure in the three positions (statistically significant differences between supine, inflated cuff and Trendelenburg positions by one-way ANOVA for mean diastolic (type III sum of squares=9.1x105, F=2449.2, P<.001) and systolic blood pressures (type III sum of squares=2.4x106, F=7150.8, P<.001). No post-hoc tests.
See this image and copyright information in PMC

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