Effect of Shoulder Traction on Size and Relative Position of Internal Jugular Vein to Carotid Artery

Effect of Shoulder Position and Head Rotation on Size and Relative Position of Internal Jugular Vein to Carotid Artery in Infants and Children

Internal jugular vein (IJV) catheterization is frequently performed in infants undergoing major surgery. Although it has been suggested that head rotation increases the degree of overlapping between IJV and carotid artery (CA), IJV catheterization without head rotation is extremely difficult in infants. The aim of the present study is to evaluate whether the caudo-lateral traction of the ipsilateral arm can decrease the degree of overlapping between IJV and CA in infants during head rotation.

Study Overview

• Status: Unknown
• Conditions: Infants; Internal Jugular Vein Cannulation; Common Carotid Artery
• Intervention / Treatment: Other: caudo-ipsilateral traction of shoulder; Other: The ultrasonographic measurements without shoulder traction

Detailed Description

Central venous catheterization is frequently performed in pediatric patients undergoing major surgery for fluid management and vasoactive drug therapy. Compared to subclavian vein, internal jugular vein (IJV) is generally preferred for catheterization because of the low incidence of serious complications, such as pneumothorax and hemothorax. However, especially in infants, IJV catheterization is still technically difficult because of the small size of the vein and anatomical variation.

In previous studies, ultrasound guidance and keeping in neutral head position have been recommended to increase the success rate and to decrease the overlap between carotid artery (CA) and IJV, respectively. However, devices for ultrasonography are not always available. Moreover, IJV catheterization without head rotation could be extremely difficult in infants because of relative the larger skull and the smaller neck than those of adults. Therefore, a simple method to relieve the overlap between CA and IJV would be needed.

During head rotation to the contralateral side, the cephalic part of IJV is moved to the same direction. Accordingly, the investigators thought that the counter traction of the caudal part of IJV using the caudo-lateral traction of the ipsilateral arm might relieve the overlap caused from head rotation. Therefore, the investigators evaluated the effect of the caudo-lateral traction of the ipsilateral arm on the overlap between common CA and IJV in infants.

• Study Type: Interventional
• Enrollment (Anticipated): 25
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jong Hwan Lee, MD, PhD; Phone Number: 82-2-3410-1928; Email: jonghwan75.lee@samsung.com
• Study Contact Backup: Name: Ae Ryoung Lee, MD; Phone Number: 82-2-3410-1929; Email: nanrong.lee@samsung.com

Study Locations

• Korea, Republic of
  • Seoul, Korea, Republic of, 135-710
    • Recruiting
    • Samsung Medical Center
    • Contact: Won Ho Kim, MD; Phone Number: 82-2-3410-2470; Email: bullet57@naver.com
    • Contact: Jong Hwan Lee, MD, PhD; Phone Number: 82-2-3410-1928; Email: jonghwan75.lee@samsung.com
    • Sub-Investigator: Jong Hwan Lee, MD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 month to 1 year (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• infants undergoing elective surgery

Exclusion Criteria:

• subjects with congenital heart disease or mass in head and neck
• Subjects with anatomical malformation of great vessels
• previous central venous access via IJV

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Shoulder traction; The ultrasonographic measurements with shoulder traction	Other: caudo-ipsilateral traction of shoulder; After the head rotation (0, 40, 80 degrees) to the contralateral side from the ultrasound measuring site, the slight caudo-ipsilateral traction of shoulder will be applied without changing the degree of the head rotation.
Active Comparator: No traction; The ultrasonographic measurements without shoulder traction	Other: The ultrasonographic measurements without shoulder traction; After the head rotation (0, 40, 80 degrees) to the contralateral side from the ultrasound measuring site, the no traction of shoulder will be applied.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Carotid artery (CA) overlap (%)	CA overlap = (overlap distance between CA and internal jugular vein)/CA diameter) × 100 measured by ultrasound image	10 seconds after head positioning

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
IJV (internal jugular vein) safety portion (%)	IJV safety portion = (1-ovelap distance/IJV diameter) × 100 measured by ultrasound image	10 seconds after head positioning
overlap distance (mm)	overlap distance (mm) of carotid artery and internal jugular vein measured by ultrasound image	10 seconds after head position
jugular to carotid distance (mm)	the distance (mm) between lateral border of carotid artery and center of internal jugula vein measured by ultrasound image	10 seconds after head position
CA diameter (mm)	carotid artery diameter (mm) measured by ultrasound image	10 seconds after head positioning
IJV diameter (mm)	internal jugualr vein diameter (mm) measured by ultrasound image	10 seconds after head positioning

Collaborators and Investigators

• Sponsor: Samsung Medical Center

Study record dates

Study Major Dates

• Study Start: August 1, 2011
• Primary Completion (Anticipated): June 1, 2012
• Study Completion (Anticipated): June 1, 2012

Study Registration Dates

• First Submitted: April 10, 2012
• First Submitted That Met QC Criteria: April 10, 2012
• First Posted (Estimate): April 11, 2012

Study Record Updates

• Last Update Posted (Estimate): April 13, 2012
• Last Update Submitted That Met QC Criteria: April 12, 2012
• Last Verified: April 1, 2012

More Information

Terms related to this study

• Keywords: infants; internal jugular vein cannulation; common carotid artery
• Other Study ID Numbers: SMC 2011-04-004-001