Internal Jugular Vein Flow in the Sitting Position

Measurement of Flow in Internal Jugular Vein in the Sitting Position: an Ultrasound Study on Healthy Volunteers

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02356887

Enrollment

Registered

2015-02-05

Start date

2015-02-28

Completion date

2015-09-30

Last updated

2023-01-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Jugular Venous Flow

Brief summary

During neurosurgical procedures, patients need to be placed in sitting position for surgical access especially in surgeries in the vertex or posterior fossa. Due gravitational effect of sitting position the flow in IJV may be reduced. Venous air embolism (VAE) is a common complication of sitting position craniotomy and carries high mortality and morbidity. Venous pressure decreases as the head of the patient is raised above the heart. Hence, negative venous pressure in the cerebral venous system promotes entrapment of air in accidental opening of the sinuses. Common methods to prevent VAE in sitting position include increasing the venous pressure by either jugular venous compression and/or increasing the venous pressure by adding positive end expiratory pressure (PEEP). Both these methods can decrease venous return and can lead to brain swelling.. In addition, improper neck position can cause the kinking of the IJV which may lead to decreased venous drainage and increased ICP. This has been shown to be the contributing factor for intraoperative brain swelling and postoperative neck and tongue swelling leading to airway obstruction. Optimal brain perfusion is best in the neutral position of the head, but surgery cannot always be performed with this.

Detailed description

Currently, there are no studies that looked into the IJV flow in sitting position and effect of venous outflow obstruction on the IJV flow. Valsalva maneuver (forced inspiration with closed glottis) and /or compression of internal jugular veins (IJV) are the two commonly used physiological methods that can cause venous outflow obstruction. A custom made neck collar can be used for compression of internal jugular vein and previous investigations have used a similar device in a rat model to demonstrate the protective effects on slosh-mediated brain injury by increasing intracranial blood volume . While the collars have not yet been studied on people for their effectiveness at preventing concussions, many studies have looked at the effect of neck collars on both jugular compression and ICP.. The purpose of this study is to measure the venous blood flow of healthy volunteers by the use of an ultrasound and Doppler velocimetry in sitting position. the investigators will measure the IJV flow on both sides in sitting position at rest and at two conditions of venous outflow obstruction- 1. Neck compression using a custom made collar and 2. During 30 seconds Valsalva maneuver. This study will provide information on the cerebral venous drainage. This information will be very useful in planning and positioning of patients undergoing neurosurgical procedures and to prevent complications from the improper patient position.

Interventions

DIAGNOSTIC_TESTJugular venous ultrasound

All volunteers will be fully awake throughout the study and be kept comfortable. A cross will be marked where the left and right IJV cross the level of C6. This is where all the measurements will be taken in 3 different conditions at rest, jugular occlusion and valsalva maneuver. At each conditions, the left and right IJV will be scanned with an ultrasound measuring the cross sectional area and Doppler velocity of the IJV. The least amount of pressure will be used to press on the ultrasound probe and the measurements will be obtained at end inspiration. The IJV flow is then calculated.

Study design

Allocation

Intervention model

SINGLE_GROUP

Primary purpose

DIAGNOSTIC

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

* Adult healthy volunteers who are above the age of 18 ASA 1 * Body mass index (BMI) less than and equal to 35

Exclusion criteria

* Lack of informed consent * Language barrier * Medical students and anesthesia residents going through the department as part of their rotation

Design outcomes

Primary

Measure	Time frame	Description
Right Internal Jugular	one day	Comparisons of right internal jugular vein ﬂow in the sitting position at rest and with application of the cervical collar
Internal Jugular Venous Flow	1 day	Right Internal Jugular Vein Flow in the sitting position.
Left Internal Jugular Vein Flow	1 day	left internal jugular vein cross-sectional area in the sitting position at rest and with application of the cervical collar.
Right Internal Jugular Vein Flow in the Sitting Position	one day	Right internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar

Secondary

Measure	Time frame	Description
Left Internal Jugular Vein Flow in the Sitting Position	One day	Comparisons of left internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar
Left Internal ﬂow in the Sitting Position	One day	left internal jugular vein ﬂow in the sitting position at rest and with application of the cervical collar

Countries

Canada

Participant flow

Participants by arm

Arm	Count
Sitting Position The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points	12
Total	12

Withdrawals & dropouts

Period	Reason	FG000
Overall Study	poor compliance	2

Baseline characteristics

Characteristic	Sitting Position	—
Age, Categorical healthy adult volunteers>18 yr <=18 years	0 Participants	—
Age, Categorical healthy adult volunteers>18 yr >=65 years	0 Participants	—
Age, Categorical healthy adult volunteers>18 yr Between 18 and 65 years	10 Participants	—
Race and Ethnicity Not Collected	—	— Participants
Sex: Female, Male Female	2 Participants	—
Sex: Female, Male Male	8 Participants	—

Adverse events

Event type	EG000 affected / at risk
deaths Total, all-cause mortality	0 / 10
other Total, other adverse events	0 / 10
serious Total, serious adverse events	0 / 10

Outcome results

Primary