• Kenji Kayashima, Masaya Ueki, and Yuki Kinoshita.
• Department of Anesthesia, Kyushukoseinenkin Hospital, Kitakyushu 806-8501.
• Masui. 2013 Jan 1;62(1):64-70.

BackgroundThe head-down tilt is thought to increase the cross-sectional areas (CSAs) of the vein in central venous catheterization. In this study, the effectiveness of the head-down tilt was investigated in children.MethodsForty patients were divided into two groups: L (n = 20) less than 8.3 kg and H (n = 20) more than 8.3 kg in weights. Right IJVs were described with the ultrasound echo at the middle of the neck. The maximal width (W) and thickness (T) of the IJVs were measured at 0, 10, and 20 degrees head-down. The IJV CSAs and the flattening ratios were calculated as pi x W x T x 2(-2) and as 1-T/W respectively. It is considered significant when the CSA increase ratio is more than 20%.ResultsPatients were 9.0 in median months of age. The increase ratio of CSA in group H at 10 degrees was 27% when the flattening ratios at 0 degrees were more than 0.30. In group L the increases in ratios of CSA were less than 5% when the flattening ratios at 0 degrees were less than 0.30.ConclusionsThe head-down at 10 degrees effectively increased the CSA when the IJV flattening ratios at 0 degrees was more than 0.3 in group H.

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