• Pelin Karaaslan, Banu Vural Gokay, Muhammet Ahmet Karakaya, Kamil Darcin, Afak Durur Karakaya, Tugrul Ormeci, and Emine Arzu Kose.
• Dr. Pelin Karaaslan, Department of Anesthesiology and Reanimation,, Istanbul Medipol University,, TEM Avrupa Otoyolu Goztepe, Cikisi No: 1,, Bagcilar, Istanbul 34078,, Turkey, T: +902127607831, drpelinsesli@hotmail.com, http://orcid.org/0000-0002-5273-1871.
• Ann Saudi Med. 2017 Jul 1; 37 (4): 308-312.

BackgroundCentral venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver.ObjectiveCompare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique.DesignProspective clinical study.SettingUniversity hospital.Subjects And MethodsHealthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated.Main Outcome Measure(S)Hemodynamic measurements and RIJV dimensions.ResultsIn 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P < .001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and < .001 for cross-sectional area and diameter, respectively).ConclusionChannelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position.LimitationsNo catheterization and study limited to healthy volunteers.

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