Madam,
We read with interest the article “Assessment of head and neck position for optimal ultrasonographic visualization of the internal jugular vein and its relation to the common carotid artery: A prospective observational study” by Purohit et al.[1] The author has conducted a very good study regarding the assessment of neck position and ultrasonographic visualization of internal jugular vein (IJV) and its relation to the common carotid artery (CCA) in different head rotations. However, we wish to add certain points regarding this study. A successful central venous cannulation (which is the main aim of ultrasonographic visualization of IJV and CCA) depends on 2 factors—a good size of the IJV and a favorable position of IJV in relation to CCA. The IJV size or diameter (on both right and left side of neck) varies according to the site of a puncture in the neck. The IJV and CCA traverse in the triangle formed by two heads of the sternocleidomastoid muscle and IJV can be punctured anywhere from the apex, middle, or base of the triangle. In a similar study done by us in healthy volunteers,[2] we found that as one goes down from apex to base of the triangle, the diameter of IJV increases on both the right and left side of the IJV. The most favorable position of IJV in relation to CCA is lateral and the next favorable is anterolateral. For successful IJV cannulation neutral or 30-degree head rotation is considered as the most favorable as compared to other head rotations. We want to highlight that while cannulating the IJV, it is always safer and better to visualize the largest diameter of IJV in addition to the most favorable position of IJV in relation to CCA by choosing apex, middle, or base of the triangle formed by sternocleidomastoid muscle by ultrasonographic visualization.
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Conflicts of interest
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References
- 1.Purohit G, Setlur R, Dhar M, Bhasin S. Assessment of head and neck position for optimal ultrasonographic visualisation of the internal jugular vein and its relation to the common carotid artery: A prospective observational study. J Anaesthesiol Clin Pharmacol. 2020;36:62–5. doi: 10.4103/joacp.JOACP_330_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Solanki SL, Doctor JR, Kapila SJ, Jain A, Joshi M, Patil VP. Ultrasonographic assessment of internal jugular vein diameter and its relationship with the carotid artery at the apex, middle, and base of the triangle formed by two heads of sternocleidomastoid muscle: A pilot study in healthy volunteers. Saudi J Anaesth. 2018;12:578–83. doi: 10.4103/sja.SJA_309_18. [DOI] [PMC free article] [PubMed] [Google Scholar]