The Influence of Passive Leg Elevation on the Cross-sectional Area of the Internal Jugular Vein in Infants or Young Children Undergoing Open Heart Surgery

The trendelenburg position is usually applied to increase the cross-sectional area of the IJV. However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated.

The investigators evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.

Study Overview

• Status: Completed
• Conditions: Infants or Children Undergoing Open Heart Surgery
• Intervention / Treatment: Other: leg elevation; Other: Trendelenburg position; Other: Trendelenburg position + passive leg elevation; Other: control group

Detailed Description

Internal jugular vein (IJV) cannulation is essential for open heart surgery of small infants and children for transfusion or inotropics infusion. The trendelenburg position is usually applied to increase the cross-sectional area of the IJV.

However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated. Furthermore, the children undergoing open heart surgery due to cardiac anomaly have an altered hemodynamics and often congested right heart. Therefore, the response of passive leg elevation may be different from that of normal heart physiology. Therefore, we evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.

• Study Type: Observational
• Enrollment (Actual): 90

Contacts and Locations

Study Locations

• Korea, Republic of
  • Seoul, Korea, Republic of, 135-710
    • Samsung Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 5 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

infants or children undergoing open heart surgery for congenital anomaly for study period

Description

Inclusion Criteria:

• infants or children under 5 yrs undergoing elective open heart surgery for congenital anomaly for study period

Exclusion Criteria:

• previous history of internal jugular vein cannulation
• concurrent pulmonary disease that can influence the hemodynamics of right heart
• increased intracranial pressure
• hemodynamic unstability

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
patients undergoing open heart surgery; small infant or children patients undergoing open heart surgery	Other: leg elevation; bilateral passive leg elevation for 30 seconds; Other: Trendelenburg position; Trendelenburg position (15 degrees) for 30 seconds; Other: Trendelenburg position + passive leg elevation; Trendelenburg position + passive leg elevation; Other: control group; supine position without passive leg elevation or trendelenburg position

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cross-sectional area of internal jugular vein	Cross-sectional area of internal jugular vein measured on the ultrasonographic image with planimetry method	one time measurement 10 min before jugular vein cannulation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Transverse diameter of internal jugular vein	Transverse diameter of internal jugular vein measured on the ultrasonographic image	only one time measurements 10 min before internal jugular vein cannulation
horizontal diameter of internal jugular vein	horizontal diameter of internal jugular vein measured on the ultrasonographic image	only one time measurements 10 min before jugular vein cannulation
skin to internal jugular vein depth	skin to internal jugular vein depth measured on the ultrasonographic image	one time measurement 10 min before jugular vein cannulation

Collaborators and Investigators

• Sponsor: Samsung Medical Center
• Investigators: Principal Investigator: Chung Su Kim, M.D.,Ph.D., Samsung Medical Center

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): December 1, 2011
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: July 22, 2011
• First Submitted That Met QC Criteria: July 22, 2011
• First Posted (Estimate): July 25, 2011

Study Record Updates

• Last Update Posted (Estimate): December 25, 2013
• Last Update Submitted That Met QC Criteria: December 24, 2013
• Last Verified: December 1, 2013

More Information

Terms related to this study

• Keywords: cross-sectional area; open heart surgery; internal jugular vein cannulation; passive leg elevation; trendelenburg position
• Other Study ID Numbers: 2011-05-093