Effect of Internal Jugular Vein Catheterization on Intracranial Pressure and Intracranial Blood Flow

Effect of Internal Jugular Vein Catheterization on Intracranial Pressure Assessed by Optic Nerve Sheath Diameter and Carotid Doppler Ultrasonography: a Prospective Observational Study

This prospective observational study aims to evaluate the effect of internal jugular vein catheterization on intracranial pressure using optic nerve sheath diameter (ONSD) measurements and carotid artery Doppler ultrasonography in adult patients undergoing surgery under general anesthesia.

ONSD will be measured noninvasively using transorbital ultrasonography, and carotid Doppler parameters will be assessed at two time points: after endotracheal intubation and approximately 5 minutes after catheterization. The primary objective is to assess short-term changes in ONSD following catheterization.

Secondary objectives include evaluating changes in carotid Doppler measurements and their relationship with ONSD, as well as associations with physiological parameters such as blood pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide.

Study Overview

• Status: Not yet recruiting
• Conditions: Ultrasonography; Intracranial Pressure
• Intervention / Treatment: Procedure: Internal Jugular Vein Catheterization

Detailed Description

This prospective observational study is designed to investigate the effect of internal jugular vein catheterization on intracranial pressure using noninvasive ultrasonographic methods in adult patients undergoing elective surgery.

Internal jugular vein catheterization will be performed as part of routine clinical care in patients requiring central venous access. The study does not introduce any additional intervention beyond standard clinical practice.

Intracranial pressure will be indirectly assessed by measuring optic nerve sheath diameter (ONSD) using transorbital ultrasonography with a high-frequency linear probe. Measurements will be obtained at a standardized depth of 3 mm posterior to the optic disc.

In addition, carotid artery Doppler ultrasonography will be performed to assess hemodynamic parameters, including flow velocities and derived indices.

All ultrasonographic measurements will be performed at two predefined time points: after endotracheal intubation and approximately 5 minutes following internal jugular vein catheterization. Measurements will be obtained from the side of catheterization.

The primary outcome is the change in ONSD following internal jugular vein catheterization. Secondary outcomes include changes in carotid Doppler parameters and their relationship with ONSD, as well as associations with physiological variables such as blood pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide.

Ultrasonographic assessments are noninvasive and considered safe, with no known risk to participants. All data will be collected prospectively and analyzed to evaluate short-term physiological changes associated with the procedure.

• Study Type: Observational
• Enrollment (Estimated): 61

Contacts and Locations

• Study Contact: Name: Ayça Sultan Şahin, Prof. Dr.; Phone Number: +905323100840; Email: aycasultan@gmail.com
• Study Contact Backup: Name: Aysun Edehan, MD; Phone Number: +905309127017; Email: aysn.997@gmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye)
      • University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital
      • Contact: Aysun Edehan, MD; Phone Number: +905309127017; Email: aysn.997@gmail.com
      • Contact: Ayça Sultan Şahin, Prof Dr; Phone Number: +905323100840; Email: aycasultan@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Adult patients undergoing surgical procedures under general anesthesia at a tertiary care hospital, in whom internal jugular vein catheterization is performed as part of routine clinical care.

Description

Inclusion Criteria:

• Age ≥18 years
• Patients undergoing surgery under general anesthesia
• Patients requiring internal jugular vein catheterization as part of routine clinical care
• Ability to obtain optic nerve sheath diameter measurements using transorbital ultrasonography
• Provision of informed consent

Exclusion Criteria:

• Known intracranial pathology affecting intracranial pressure
• Ocular conditions preventing accurate ultrasonographic measurement (e.g., orbital trauma, ocular surgery, infection)
• Hemodynamic instability
• Contraindication to internal jugular vein catheterization
• Inability to obtain adequate ultrasound images

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Adult Patients Undergoing Internal Jugular Vein Catheterization; Adults undergoing elective surgery under general anesthesia who require internal jugular vein catheterization as part of routine clinical care. Intracranial pressure will be assessed noninvasively using optic nerve sheath diameter measurements obtained before and after catheterization.

Procedure: Internal Jugular Vein Catheterization; Internal jugular vein catheterization is performed in patients undergoing major surgical procedures when clinically indicated as part of routine perioperative care. The procedure is not assigned by the study. Additional non-invasive ultrasound measurements, including optic nerve sheath diameter assessment, are obtained to evaluate physiological changes associated with catheterization without altering standard clinical management. Ultrasonography is a non-invasive and safe imaging method routinely used in clinical practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Optic Nerve Sheath Diameter (mm) Following Internal Jugular Vein Catheterization	Optic nerve sheath diameter (ONSD) will be measured in millimeters using transorbital ultrasonography at 3 mm posterior to the optic disc on the side of catheterization. The outcome is defined as the difference between measurements obtained immediately after endotracheal intubation (baseline) and 5 minutes after internal jugular vein catheterization. Higher values indicate increased optic nerve sheath diameter.	Baseline (immediately after endotracheal intubation) and 5 minutes after internal jugular vein catheterization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Internal Carotid Artery Peak Systolic Velocity (PSV) Following Internal Jugular Vein Catheterization	Peak systolic velocity (PSV) of the internal carotid artery will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation (baseline) and post-catheterization values.	Baseline (immediately after endotracheal intubation) and 5 minutes after internal jugular vein catheterization
Change in Internal Carotid Artery End-Diastolic Velocity (EDV) Following Internal Jugular Vein Catheterization	End-diastolic velocity (EDV) of the internal carotid artery will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in Internal Carotid Artery Time-Averaged Maximum Velocity (TAMAX) Following Internal Jugular Vein Catheterization	Time-averaged maximum velocity (TAMAX) will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in Internal Carotid Artery Pulsatility Index (PI) Following Internal Jugular Vein Catheterization	Pulsatility index (PI) will be calculated from Doppler measurements (unitless). The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in Internal Carotid Artery Systolic/Diastolic Ratio (S/D) Following Internal Jugular Vein Catheterization	The systolic/diastolic (S/D) ratio will be calculated from Doppler measurements (unitless). The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in Mean Arterial Pressure (MAP)	Mean arterial pressure (MAP) will be measured in mmHg. The outcome is defined as the difference between post-intubation (baseline) and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in Heart Rate	Heart rate will be measured in beats per minute (bpm). The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization
Change in End-Tidal Carbon Dioxide (EtCO₂)	End-tidal carbon dioxide (EtCO₂) will be measured in mmHg. The outcome is defined as the difference between post-intubation and post-catheterization values.	Baseline and 5 minutes after internal jugular vein catheterization

Collaborators and Investigators

• Sponsor: Kanuni Sultan Suleyman Training and Research Hospital

Publications and helpful links

General Publications

• Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011 Jul;37(7):1059-68. doi: 10.1007/s00134-011-2224-2. Epub 2011 Apr 20.
• Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, Taccone FS, Citerio G. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018 Aug;44(8):1284-1294. doi: 10.1007/s00134-018-5305-7. Epub 2018 Jul 17.
• Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008 Nov;34(11):2062-7. doi: 10.1007/s00134-008-1149-x. Epub 2008 May 29.

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): March 15, 2027
• Study Completion (Estimated): March 16, 2027

Study Registration Dates

• First Submitted: March 26, 2026
• First Submitted That Met QC Criteria: April 14, 2026
• First Posted (Actual): April 20, 2026

Study Record Updates

• Last Update Posted (Actual): April 20, 2026
• Last Update Submitted That Met QC Criteria: April 14, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Ultrasonography; General Anesthesia; Optic Nerve Sheath Diameter; Intracranial Pressure; Catheterization; Internal Jugular Vein
• Other Study ID Numbers: IJVC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared due to institutional policies and concerns regarding patient confidentiality and data privacy. Data may be available from the corresponding author upon reasonable request and with appropriate ethical approvals.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No