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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Infants, Internal Jugular Vein Cannulation, Common Carotid Artery

Intervention / Treatment
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* Other: caudo-ipsilateral traction of shoulder
* Other: The ultrasonographic measurements without shoulder traction


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 1 Month
Maximum Age: 12 Months

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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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Shoulder traction<br>The ultrasonographic measurements with shoulder traction | Other: caudo-ipsilateral traction of shoulder<br>* 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.<br>|
| Active Comparator: No traction<br>The ultrasonographic measurements without shoulder traction | Other: The ultrasonographic measurements without shoulder traction<br>* 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.<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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internal jugular vein cannulation, common carotid artery, infants