Internal jugular vein diameter in pediatric patients: are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound.

AIM

This study investigates whether the diameters of right internal jugular vein (RIJV) are suitable for the use of 'big radius curved J-tip' Seldinger wires in pediatric patients.

METHODS

One-hundred and thirty-five children, 1 month to 15 years of age, scheduled for pediatric surgery were divided into four subgroups according to their age (0-12 months, 1-2 years, 2-6 years old, and >6 years). Patients in the 0-12 months group were further divided into two groups as 0-6 months and 7-12 months of age to evaluate RIJV characteristics in detail. Following anesthesia induction, depth, diameter, and area of RIJV were measured with ultrasound at the level of cricoid cartilage and sterno-clavicular junction in supine and Trendelenburg position.

RESULTS

Infants in the 0-6 months of age group had the least mean diameter of RIJV at both the cricoid cartilage and the sternoclavicular junction level (0.484 +/- 0.132 and 0.499 +/- 0.136 cm). The aforementioned diameter was significantly lower than the values of other age groups (P < 0.05). Trendelenburg position did not increase RIJV diameter in children below 6 and cross-sectional area below 2 years old. Correlations between age, height, weight, head circumference and RIJV diameter, cross-sectional area, depth from the skin were weak.

CONCLUSION

The diameter of the IJV in pediatric patients, especially infants, is often smaller than the diameter of the J-tip guidewire curve. We speculate that this may lead to impeded guidewires and failed cannulation. It must also be kept in mind that the Trendelenberg position might not facilitate IJV cannulation in children <2 years of age.