Central Venous Access: The Effects of Approach, Position, and Head Rotation on Internal Jugular Vein Cross-Sectional Area

We investigated the effects of approach (lateral versus anterior), position (supine versus Trendelenburg), and head rotation (0°, 20°, and maximum) during central venous catheterization on the area of the right internal jugular vein. Twenty-four patients were placed in supine position, followed by 25° of Trendelenburg position. In each position, measurement of the anterior and lateral right internal jugular vein cross-sectional areas was obtained by using planimetry with the patient’s head oriented at 0°, 20°, and maximum rotation. The largest cross-sectional areas were achieved in the lateral approach with the Trendelenburg position. In this position, no differences were detected among head rotation conditions. Data suggest that for those patients who tolerate the Trendelenburg position, the lateral access approach yields the statistically largest target area regardless of head rotation. When the Trendelenburg position is contraindicated, the results of this study suggest other approaches, e.g., the anterior approach, for central venous catheter placement that maximize the internal jugular vein area.