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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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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

Conditions
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Infants or Children Undergoing Open Heart Surgery

Intervention / Treatment
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* Other: leg elevation
* Other: Trendelenburg position
* Other: Trendelenburg position + passive leg elevation
* Other: control group


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Maximum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| patients undergoing open heart surgery<br>small infant or children patients undergoing open heart surgery | Other: leg elevation<br>* bilateral passive leg elevation for 30 seconds<br>Other: Trendelenburg position<br>* Trendelenburg position (15 degrees) for 30 seconds<br>Other: Trendelenburg position + passive leg elevation<br>* Trendelenburg position + passive leg elevation<br>Other: control group<br>* supine position without passive leg elevation or trendelenburg position<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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internal jugular vein cannulation, cross-sectional area, passive leg elevation, trendelenburg position, open heart surgery