Is head rotation preferred during right internal jugular vein cannulation in obese asians?

Background: Obese subjects are considered to be a difficult group for central vein cannulation. We investigated the optimal position for right internal jugular vein (IJV) cannulation in relation to BMI in Asians. Methods: 102 subjects were divided into three groups; 34 with a BMI of less than 25 kg/m² (Group III), 34 with a BMI from 25 to 30 kg/m² (Group II), and 34 with a BMI of 30 kg/m² or above (Group III). Using a 5-12 MHz linear probe of an ultrasound system, the IJV depth, the diameter of the IJV and common carotid artery (CCA) and overlap length between them were measured at six positions: 0°, 30°, and 60° of head rotation to the contralateral side combined with 0° and 10° of Trendelenburg tilt. Results: The IJV depth was deepest in Group III and significantly shorter at 10° Trendelenburg tilt compared to 0° Trendelenburg tilt. The IJV diameter increased by 10 to 20% with 10° Trendelenburg tilt and there were not significant change by head rotation or BMI. The overlap of the IJV and CCA was significantly increased in Group III compared to Group I and in Group III, there were significant increases of the overlap according to the degree of head rotation, regardless of Trendelenburg tilt. Conclusion: We recommend head rotation less than 30° with 10° Trendelenburg tilt for right IJV cannulation, especially in obese Asians. In obese subjects, real-time ultrasound should be considered. Further study with actual cannulation is needed for availability of clinical outcome.