The Influence of Passive Leg Elevation on the Cross-sectional Area of the Internal Jugular Vein in Infants or Young Children Undergoing Open Heart Surgery

Completed

• Conditions: Infants or Children Undergoing Open Heart Surgery
• Interventions: Other: leg elevation; Other: Trendelenburg position; Other: Trendelenburg position + passive leg elevation; Other: control group

• Registration Number: NCT01401920
• Lead Sponsor: Samsung Medical Center

Brief Summary

The trendelenburg position is usually applied to increase the cross-sectional area of the IJV. However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated.

The investigators evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.

Detailed Description

Internal jugular vein (IJV) cannulation is essential for open heart surgery of small infants and children for transfusion or inotropics infusion. The trendelenburg position is usually applied to increase the cross-sectional area of the IJV.

However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated. Furthermore, the children undergoing open heart surgery due to cardiac anomaly have an altered hemodynamics and often congested right heart. Therefore, the response of passive leg elevation may be different from that of normal heart physiology. Therefore, we evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.

Study Timeline

• Study Start: 2011-07
• Study First Submitted: 2011-07-22
• Study First Submitted QC: 2011-07-22
• Study First Posted: 2011-07-25
• Primary Completion: 2011-12
• Study Completion: 2011-12
• Status Verified: 2013-12
• Last Update Submitted: 2013-12-24
• Last Update Posted: 2013-12-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

• infants or children under 5 yrs undergoing elective open heart surgery for congenital anomaly for study period

Exclusion Criteria

• previous history of internal jugular vein cannulation
• concurrent pulmonary disease that can influence the hemodynamics of right heart
• increased intracranial pressure
• hemodynamic unstability

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
patients undergoing open heart surgery	leg elevation	small infant or children patients undergoing open heart surgery
patients undergoing open heart surgery	Trendelenburg position	small infant or children patients undergoing open heart surgery
patients undergoing open heart surgery	Trendelenburg position + passive leg elevation	small infant or children patients undergoing open heart surgery
patients undergoing open heart surgery	control group	small infant or children patients undergoing open heart surgery

Primary Outcome Measures

Name	Time	Method
Cross-sectional area of internal jugular vein	one time measurement 10 min before jugular vein cannulation	Cross-sectional area of internal jugular vein measured on the ultrasonographic image with planimetry method

Secondary Outcome Measures

Name	Time	Method
skin to internal jugular vein depth	one time measurement 10 min before jugular vein cannulation	skin to internal jugular vein depth measured on the ultrasonographic image
Transverse diameter of internal jugular vein	only one time measurements 10 min before internal jugular vein cannulation	Transverse diameter of internal jugular vein measured on the ultrasonographic image
horizontal diameter of internal jugular vein	only one time measurements 10 min before jugular vein cannulation	horizontal diameter of internal jugular vein measured on the ultrasonographic image

Trial Locations

Locations (1)

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of