Ultrasound analysis of the relationship between right internal jugular vein and common carotid artery in the left head-rotation and head-flexion position

Background Cannulation of the internal jugular vein may be associated with inadvertent puncture of the common carotid artery. Systematic use of ultrasound guidance has improved clinical success rates and reduced complications, but better knowledge of topographic relationships of the internal jugular vein and common carotid artery is desirable. This preclinical study was designed to determine by ultrasound technique relative topographic characteristics in humans of the internal jugular veins and common carotid arteries at different levels on both sides of the neck. Methods One hundred and twenty healthy volunteers were examined bilaterally by ultrasound at three neck levels with and without contralateral rotation of the head. Twelve digital pictures were recorded and used to determine venous diameters and extents of arteriovenous overlapping in each subject. Results Venous dimensions and arteriovenous overlapping were larger on the right side (p = 0.008) regardless of head rotation at all levels. There was more arteriovenous overlapping with than without rotation at right high- and mid-cervical levels (p<0.001). The only difference between right mid- and low-cervical levels was less arteriovenous overlapping at mid-cervical level without rotation (p = 0.017). The smallest venous dimensions and extent of arteriovenous overlapping were recorded at high-cervical level. Conclusions Despite similar venous dimensions, less arteriovenous overlapping regardless of head rotation at mid-cervical level, together with the pleural proximity at low-cervical level, propose the internal jugular vein to be anatomically (other factors disregarded) favorable for vascular access on the right side, at mid-cervical level, close to the angle between the sternocleidomastoid muscle bellies, and with minimal rotation of the head.

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Ultrasound Evaluation of the Effect of Head Rotation on the Relationship of the Internal Jugular Vein and Carotid Artery

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2011.06.096 ◽

2011 ◽

Vol 41 (2) ◽

pp. 213-214 ◽

Cited By ~ 1

Author(s):

R. Merritt ◽

C. Derr ◽

E. Zellavous ◽

K. Downes ◽

L. Land ◽

...

Keyword(s):

Carotid Artery ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Head Rotation ◽

Ultrasound Evaluation ◽

Relationship Of ◽

The Relationship

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Slight caudo-lateral traction of the ipsilateral arm can relieve the head rotation-induced overlap between internal jugular vein and common carotid artery in infants

European Journal of Anaesthesiology ◽

10.1097/00003643-201206001-00518 ◽

2012 ◽

Vol 29 ◽

pp. 157

Author(s):

H. Y. Lim ◽

J. H. Lee ◽

A. R. Lee ◽

H. S. Cho

Keyword(s):

Carotid Artery ◽

Internal Jugular Vein ◽

Common Carotid Artery ◽

Jugular Vein ◽

Head Rotation

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Anatomical relationship between the common carotid artery and the internal jugular vein during head rotation

Ultrasound ◽

10.1177/1742271x14524571 ◽

2014 ◽

Vol 22 (2) ◽

pp. 99-103 ◽

Cited By ~ 8

Author(s):

Izumi Miki ◽

Satoru Murata ◽

Ken Nakazawa ◽

Shiro Onozawa ◽

Takahiko Mine ◽

...

Keyword(s):

Carotid Artery ◽

Internal Jugular Vein ◽

Common Carotid Artery ◽

Jugular Vein ◽

Head Rotation ◽

Anatomical Relationship ◽

The Common

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Variations in the anatomical relationship between the common carotid artery and the internal jugular vein: An ultrasonographic study

Colombia Medica ◽

10.25100/cm.v46i2.1652 ◽

2015 ◽

pp. 54-59 ◽

Cited By ~ 3

Author(s):

Mauricio Umaña Perea ◽

Alberto Federico García ◽

José Luis Castillo García ◽

Luis Alfonso Bustamante Cristancho ◽

Juan Sebastián Martínez Collazos

Keyword(s):

Multivariate Analysis ◽

Carotid Artery ◽

Internal Jugular Vein ◽

Common Carotid Artery ◽

Jugular Vein ◽

Patients Âgés ◽

Anterior Position ◽

Anatomical Relationship ◽

The Common ◽

The Right

Introduction: The internal jugular vein locates anterior or anterolateral to the common carotid artery in two-thirds of the subjects studied by ultrasound when the head is in a rotated position. Aim: To identify variables associated with the anterior location of the internal jugular vein. Methods: Ultrasound examinations were performed with the patients in the supine position, with the head rotated to the opposite side. The proximal third of the neck was visualized transversely with a 7.5-mHz transducer. The relationship between the vessels was described in accordance with the proportion of the artery overlapped by the vein. Univariate comparisons and a multivariate analysis of potential variables that may affect the anatomic relationships were performed. Results: Seventy-eight patients were included, 44 of whom were men. The patients' ages ranged from 17 to 90 years (median 64.0, interquartile range 41-73). The right and left sides were studied 75 and 73 times, respectively. The vein was located lateral to the artery in 24.3% (95%CI= 17.4-32.2) of the studies, anterolateral in 33.8% (95%CI= 26.2-41.4) and anterior in 41.9% (95%CI= 33.9-49.8). The multivariate analysis identified age group (OR= 3.7, 95% CI 2.1-6.4) and, less significantly, the left side (OR= 1.7, 95%CI= 0.8-3.5) and male gender (OR= 1.2, 95%CI= 0.6-2.7) as variables associated with the anterior position of the vein. Conclusión: The anterior position of the internal jugular vein relative to the common carotid artery increases gradually with age. Additionally, left-sided localization and male sex further increased the probability of an anterior position.

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