Intensive Care Medicine

, Volume 34, Issue 2, pp 333–338 | Cite as

Ultrasound evaluation of central veinsin the intensive care unit:effects of dynamic manoeuvres

  • Santhi Samy Modeliar
  • Marie-Antoinette Sevestre
  • Bertrand de Cagny
  • Michel Slama
Brief Report

Abstract

Objective

To determine: (1) the proportion of small (< 5 mm) or thrombosed internal jugular veins (IJV) and femoral veins (FV) in which catheter placement would be difficult without ultrasound guidance; (2) which position increases central vein sizes and may facilitate cannulation of these vessels.

Design

Prospective study.

Setting

Twelve-bed adult medical intensive care unit.

Patients and participants

Sixty patients (62 ±  19 years, SAPS II score 36 ± 17).

Interventions

Ultrasound examinations of the IJV and FV in supine, Trendelenburg (T) and reverse Trendelenburg (Ti) positions.

Measurements and results

Maximum diameter and cross-sectional area (CSA) were measured. Venous catheter placement would have been difficult (diameter < 5 mm) or even impossible (thrombosis) for 22% of right IJV, 13% of left IJV, 2% of left and 2% of right FV. In the T position, the CSA of the IJV increased (right IJV: 1.7 ±  1.4 to 2.01 ±  1.34 cm2, left IJV: 1.18 ±  0.81 to 1.34 ±  0.85 cm2; p < 0.05) and theCSA of the FV decreased (right FV: 1.42 ±  0.61 to 1.22 ±  0.58 cm2, left FV: 1.51 ±  0.62 to 1.26 ±  0.58 cm2; p < 0.05). In the Ti position, the CSA of the IJV decreased (right IJV: 1.7 ±  1.4 to 1.35 ±  1.35 cm2, left IJV: 1.18 ±  0.81 to 0.87 ±  0.62 cm2; p < 0.05) and the CSA of the FV increased (right FV: 1.42 ±  0.61 to 1.66 ±  0.65 cm2, left FV: 1.51 ±  0.62 to 1.65 ±  0.68 cm2; p < 0.05). In two-thirds of patients, the right IJV was significantly larger than the left IJV.

Conclusions

Ultrasonography should be performed before at least central venous catheter placement to detect the presence of deep vein thrombosis or vessels less than 5 mm in diameter. Some positions increase veins' diameter at least internally, T position increasing IJV size and Ti position increasing FV size.

Keywords

Ultrasonography Internal jugular vein Femoral vein Dynamic manoeuvres Cross-sectional area 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Santhi Samy Modeliar
    • 1
  • Marie-Antoinette Sevestre
    • 2
  • Bertrand de Cagny
    • 1
  • Michel Slama
    • 1
    • 3
  1. 1.Unité de réanimationservice de néphrologieAmiensFrance
  2. 2.Laboratoire d’explorations fonctionnelles vasculairesservice de chirurgie vasculaire et thoraciqueAmiensFrance
  3. 3.Unité INSERMAmiensFrance

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