Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan

Masataka Hiruma; Hiroyuki Honda; Shuichiro Kurita; Shunsuke Nukaga; Mitsuhiro Watanabe; Kei Nishiyama

doi:10.4266/acc.002025

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Original Article Anesthesiology Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan: Acute and Critical Care 2025;40(4):574-581.
DOI: https://doi.org/10.4266/acc.002025
Published online: November 24, 2025

Masataka Hiruma¹

, Hiroyuki Honda¹

, Shuichiro Kurita²

, Shunsuke Nukaga²

, Mitsuhiro Watanabe²

, Kei Nishiyama²

¹Intensive Care Unit, Niigata University Medical and Dental Hospital, Niigata, Japan

²Advanced Disaster Medical and Emergency Critical Care Center, Niigata University Medical and Dental Hospital, Niigata, Japan

Corresponding author: Hiroyuki Honda Intensive Care Unit, Niigata University Medical and Dental Hospital, 754 Asahimachidori 1-bancho, Chuo-ku, Niigata, Niigata 951-8520, Japan Tel: +81-25-227-2758, Fax: +81-25-227-0791, Email: h.honda0914@gmail.com

• Received: June 22, 2025 • Revised: August 28, 2025 • Accepted: August 29, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
KEY MESSAGES
NOTES
REFERENCES

Abstract

Background
Real-time ultrasound-guided catheterization of the internal jugular vein (IJV) is widely used for its safety and high success rate. However, it becomes difficult when the IJV’s cross-sectional area (CSA) is reduced. A reported technique applies manual pressure (with fingers) to the supraclavicular IJV to impede venous return and enlarge the distal CSA. While effective in previous studies, its clinical utility remains unclear, as those studies involved only healthy volunteers and used blind technique. Therefore, this study aimed to evaluate the efficacy of our novel ultrasound-guided compression of the proximal IJV.
Methods
In this prospective observational study, 25 hospitalized patients were included. Two ultrasound machines were used: one to visualize the CSA of the distal IJV, and the other to apply and guide compression of the supraclavicular IJV, ensuring real-time confirmation of venous occlusion. Patients were asked about pain during the compression procedure. The primary outcome was the degree of dilation at the puncture site of the IJV.
Results
All 25 patients (mean Sequential Organ Failure Assessment score: 5.2±3.6) completed the study. Supraclavicular IJV compression resulted in a significant increase in the CSA of the distal IJV by approximately 150%, from 0.4±0.3 cm² to 1.0±0.3 cm² (P<0.001). No patient reported any pain during the procedure.
Conclusions
Ultrasound-guided supraclavicular IJV compression significantly increased the CSA of the distal IJV in hospitalized patients. This method enhances vein visibility by increasing IJV volume, potentially improving the success and safety of central venous catheterization.
Key Words: central venous catheterization; jugular veins; ultrasonography

INTRODUCTION

Central venous catheterization is an important procedure in the management of critically ill patients. Regarding the puncture method, guidelines recommend the use of real-time ultrasound guidance for venous access due to its high safety profile and success rate [1-6]. However, catheter insertion in critically ill patients can be challenging, as these individuals often present with reduced intravascular volume, resulting in diminished vessel diameter as observed on ultrasound images [7]. To address this challenge, various methods such as the Trendelenburg position [8-10], the Valsalva maneuver [11], lower leg elevation [12-14], and abdominal compression [15] have been shown to effectively increase vessel diameter. Although these methods have been reported to be effective, they are also associated with potential adverse effects, such as elevated intraocular and retinal venous pressures [16], impaired respiratory function [17], procedural discomfort [15], paradoxical narrowing of the internal jugular vein (IJV) [10,13,18], arrhythmia, and, in rare cases, even death [19].

A potentially safer method involves applying digital pressure to the cervical region just above the clavicle to impede venous return and promote dilation of the IJV at the puncture site [20,21]. However, this method is derived from a study conducted on healthy volunteers and has not been validated for efficacy in hospitalized patients [20]. Furthermore, it remains uncertain whether digital pressure truly achieves IJV occlusion. Consequently, we hypothesized that the IJV at the puncture site could be more effectively dilated using an ultrasound probe, rather than a finger, to confirm the obstruction on ultrasound images while applying pressure. If ultrasound-guided compressive occlusion of the proximal IJV is demonstrated to be effective, this method may offer a more reliable and safer method for central venous puncture. This study aimed to assess the efficacy of this ultrasound-guided supraclavicular IJV compression method in hospitalized patients.

MATERIALS AND METHODS

This prospective observational study was conducted at a single center in adherence to the principles outlined in the Declaration of Helsinki and Ethical Guidelines for Medical and Biological Research Involving Human Subjects. The study protocol was approved by the Research Ethics Committee of the Niigata University Medical and Dental Hospital, Niigata, Japan (No. 2020-0346) and was registered with the University Hospital Medical Information Network (UMIN000054649). Written Informed consent was obtained from all participants.

Study Population

Eligible participants for this study were non-intubated individuals of both sexes, aged 20 years or older, who were admitted to the critical care units of Niigata University Medical and Dental Hospital between February 24, 2021, and January 17, 2024, and who underwent ultrasound evaluation during the working hours of the first author (Figure 1). Exclusion criteria included the following: stenosis or obstruction of the IJV; failure to complete the ultrasound examination; the presence of medical devices in the neck; inability to follow instructions; and inability to obtain informed consent for participation in the research. However, no patients were excluded based on these criteria.

Research Procedures

Patients were positioned supine without a pillow, with their heads rotated 30° to the left. A 6–13 MHz linear probe of the ultrasound machine (device A; SonoSite X-Porte, Fujifilm or LOGIQ P10, GE Healthcare) was positioned at the puncture site—specifically, at the apex of the Sedillot triangle, which is delineated by the right clavicle of the neck and the head of the sternocleidomastoid muscle. The ultrasound image was subsequently examined, and the probe’s position was adjusted to ensure that the IJV was centrally displayed on the screen. The ultrasound probe was secured with a custom-made fixture (Figure 2A) to prevent movement during the study operation and to allow objective measurement of the IJV at the puncture site. Subsequently, an additional ultrasound machine (device B; SonoSite NanoMaxx, Fujifilm) was prepared. The 6–13 MHz linear probe of the aforementioned system was then positioned directly above the right clavicle, manually rendering the IJV visible in the central region of the ultrasound image (Figure 2B). Utilizing this probe, pressure was gradually applied to the neck, and the IJV was visually confirmed to be completely occluded in the ultrasound image (Figure 2B). Thus, the qualitative assurance of the IJV compression method's effectiveness was achieved. The anteroposterior and transverse diameters of the IJV at the puncture site, as well as the cross-sectional area (CSA) measured using the tracing function of the ultrasound measuring device, were measured before and after compression, respectively. Compression of the IJV at the supraclavicular site was limited to 10 seconds. The measurements of the puncture site IJV were obtained at the end of expiration. In an effort to minimize the impact of method bias, all procedures were carried out by the same investigator using the same device. Patient demographics—including age, sex, height, weight, medical history, diagnosis, and Sequential Organ Failure Assessment (SOFA) score—were extracted from electronic medical records. Additionally, patients were inquired about the presence of pain during the ultrasound-guided IJV compression, and their responses were systematically recorded.

Statistical Analysis

Data are presented as numbers (percentage) for categorical variables and as means (standard deviation) for continuous variables. The sample size was calculated to detect a difference of 0.4 cm² in the puncture site IJV, with a power of 0.8, a significance level of 0.05, and a standard deviation of 0.5, based on previous studies [20]. This indicated that a minimum of 25 cases was required. The normality of continuous variables was visually assessed using quantile–quantile plots, and paired t-tests were used to compare the two groups. Missing data not exceeding 10% of total observations were ignored. All statistical analyses were performed using EZR (version 1.61, Saitama Medical Center, Jichi Medical University) [22], a graphical user interface for R (version 2.8.0, R Foundation for Statistical Computing). A two-sided P-value of <0.05 was considered statistically significant.

RESULTS

The characteristics of the study population are summarized in Table 1. Half of the patients were male, with a mean age of 71±14 years. Trauma was the most common reason for hospitalization (n=13, 5%), followed by sepsis (n=4, 16%). Height data were missing for two patients, and weight data were missing for one patient. The mean height was 160.7±9.9 cm, and the mean weight was 57.0±12.6 kg. The mean SOFA score was 5.2±3.6. The use of ultrasound-guided supraclavicular IJV compression method resulted in a 150% increase in the CSA of the IJV at the puncture site (Table 2, Figure 3). The anteroposterior and transverse diameters of the vessels in the puncture site IJV also increased significantly (Table 2, Figure 4). The largest observed increase in vessel dimensions was from 1.4 mm to 5.4 mm in the anteroposterior diameter, from 4.3 mm to 18.3 mm in the transverse diameter, and from 0.1 cm² to 1.2 cm² in CSA. Importantly, none of the patients reported any pain during the procedure.

DISCUSSION

This study evaluated whether ultrasound-guided supraclavicular compression of the IJV can effectively dilate the IJV at the puncture site in hospitalized patients, potentially improving conditions for central venous catheter insertion. The findings demonstrated that when the IJV is reliably occluded under ultrasound visualization by compressing the supraclavicular region with an ultrasound probe, the CSA of the IJV at the puncture site is dilated by approximately two times. No patients reported pain or other discomfort associated with the compression. Yang et al. [15] reported that the success rate of central venous catheter insertion was significantly higher when the CSA, circumferential diameter, and anteroposterior diameter of the IJV were larger. Moreover, clinical guidelines have indicated that a reduction in the diameter or CSA of the IJV is associated with increased difficulty in venous catheterization [3]. Therefore, as a corollary, a safer and more dependable central venous catheterization may be achieved using this reliable IJV occlusion method with an ultrasound probe.

Lee et al. [23] observed that the size of the IJV increases with rising positive end-expiratory pressure (PEEP). This phenomenon occurs because elevated intrathoracic pressure impedes venous return to the heart, resulting in an increased volume in the IJV. Similarly, we hypothesize that the placement of the ultrasound probe on the IJV obstructs blood flow and causes dilation of the upstream veins. In the present study, the IJV size at the puncture site was enlarged by 0.6 cm², representing a 150% increase compared to pre-compression measurements. This increase is greater than the 0.2 cm² (19%) increase reported in a previous study using blind finger compression of the neck [20]. This discrepancy may be attributed to the ultrasound technique’s ability to visually confirm reliable occlusion of the IJV. Another possible explanation is that, unlike previous studies, the present study involved hospitalized patients. Nakamura et al. [24] demonstrated that low blood volume was associated with reduced IJV size. The IJV size before compression in our patients was smaller than that reported by Nakamura et al. [24], suggesting the possibility of dehydration. For patients with low blood volume, ultrasound-guided identification and occlusion of the IJV may be more reliable and effective than blind finger compression.

We believe that ultrasound-guided supraclavicular IJV compression offers several advantages over conventional methods in terms of the IJV dilation mechanism. Xie et al. [14] reported the efficacy of passive lower extremity elevation, which resulted in an approximately 0.3 cm² (20%) increase in the CSA of the IJV. Wang et al. [8] investigated the effect of the Trendelenburg position include intubated patients, reporting an approximate 0.4 cm² (72%) increase in IJV CSA. These methods move blood volume to the upper body and distribute it evenly. In contrast, ultrasound-guided compression of the supraclavicular IJV selectively and effectively increases blood volume within the targeted IJV. The Valsalva maneuver and abdominal compression dilate the IJV by increasing intrathoracic or intra-abdominal pressure, thereby inhibiting venous return to the heart [23,25]. Comparing both methods, a greater CSA dilation effect was observed with PEEP at 9 cm H₂O than with an intraperitoneal pressure of 17–20 cm H₂O. This finding suggests that intrathoracic pressure—being closer to the neck—has a greater effect on IJV dilation than intra-abdominal pressure. In other words, ultrasound-guided supraclavicular IJV compression may be more effective by inhibiting venous return near the puncture site to promote localized vein dilation.

From a patient safety perspective, the ultrasound-guided supraclavicular IJV compression method is considered a minimally invasive approach. The venous compression technique used in this study corresponds to the method routinely employed to distinguish arteries from veins during ultrasound examinations. Notably, no patients reported pain or discomfort during the compression procedure. Furthermore, as this method does not necessitate positional changes or the use of positive pressure ventilation, it is unlikely to negatively impact respiratory function or circulatory dynamics [17].

We assert that this method is applicable in clinical settings. For instance, if the physician encounters difficulty performing the puncture due to a collapsed IJV, an additional ultrasound device can be used, and an assistant can be directed to apply pressure until the supraclavicular IJV is visibly occluded on the ultrasound image. This method is required solely for the initial puncture and does not necessitate sustained compression until the central venous catheter is inserted. The ultrasound equipment need not be identical to that used in this study; commonly available equipment may be utilized as a substitute. While an assistant is essential to perform the compression, it is generally advisable for more than one person to be involved in central venous catheter insertion [1]. Although a second ultrasound machine is necessary, it constitutes a justifiable investment to improve the safety of the puncture procedure.

This study has some limitations. First, it was an observational study conducted at a single institution, and external validation in a more diverse patient population would be beneficial. Second, although we demonstrated the effect of IJV dilation, we did not assess the actual success rate of catheter insertion. However, previous reports have demonstrated that enlargement of the IJV diameter is associated with higher success rates [15]. Our study also provides evidence contributing to this background. Although we did not directly evaluate insertion success rates, we showed that the presence or absence of the maneuver resulted in differences in vessel diameter as well as CSA. This finding suggests a potential for improving success rates in clinical practice. Future studies are needed to directly investigate the clinical significance of this intervention, with primary outcomes such as actual puncture success rates and complication rates.

This study demonstrated that ultrasound-guided supraclavicular IJV compression effectively dilates the IJV at the puncture site in hospitalized patients. We believe this method is relatively simple and minimally invasive. Future studies should investigate whether it improves the success rate of central venous catheter placement.

KEY MESSAGES

• Central venous catheterization can be challenging in critically ill patients with a collapsed internal jugular vein (IJV).

• Ultrasound-guided supraclavicular IJV compression significantly increases the cross-sectional area at the puncture site without causing discomfort.

• This novel, minimally invasive method has been validated in hospitalized patients and may improve the success and safety of central venous access.

NOTES

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

Conceptualization: MH, HH. Data curation: MH, HH, SK. Formal analysis: MH, HH, SK, MW, SN, KN. Methodology: MH, HH, SK, MW, SN, KN. Project administration: MH. Visualization: MH, HH. Writing – original draft: MH, HH, SK. Writing – review & editing: MH, HH, SK, MW, SN, KN. All authors read and agreed to the published version of the manuscript.

Figure 1.

Flowchart of the study.

Figure 2.

Demonstration of the ultrasound-guided supraclavicular internal jugular vein (IJV) compression method. (A) Demonstration of measurement using the custom-made ultrasound probe fixation device. The ultrasound probe is positioned at the puncture point of the IJV (device A) and remains fixed throughout the measurement by the custom-made ultrasound probe fixation device. The supraclavicular IJV is then compressed with another ultrasound transducer (device B). (B) Schematic of the ultrasound-guided supraclavicular IJV compression method. Compression of the IJV directly beneath device B creates a temporary occlusion (indicated by red arrows), blocking venous return and causing dilation of the IJV directly beneath device A (indicated by blue arrows). CCA: common carotid artery. CCA: common carotid artery.

Figure 3.

Changes in the cross-sectional area (CSA) of the internal jugular vein (IJV) with the ultrasound-guided supraclavicular internal jugular vein compression method. P-values are calculated using paired t-test. The line graph shows the CSA of the puncture point of the IJV before and after applying the ultrasound-guided supraclavicular internal jugular vein compression method. The largest observed increase in vessel dimensions was from 0.1 cm² to 1.2 cm² in CSA. No cases of decreased CSA are reported.

Figure 4.

Changes in the anteroposterior (A) and transverse (B) diameters of the internal jugular vein (IJV) when applying the ultrasound-guided supraclavicular IJV compression method. P-values are calculated by paired t-test. In both panels, no decreases were observed.

Table 1.

Background characteristics of patients

Variable	Value (n=25)
Male sex	13 (52)
Age (yr)	71±14
Height (cm)	160.7±9.9
Weight (kg)	57.0±12.6
SOFA score	5.2±3.6
Medical history
Hypertension	9
Dyslipidemia	3
Diabetes	4
Malignant tumor	2
Cardiovascular disease	5
Cerebrovascular disease	5
Respiratory disease	2
Kidney and urologic diseases	4
Musculoskeletal disease	4
Gastrointestinal diseases	1
Mental disorders	3
Ophthalmic diseases	1
Reason for hospitalization
Trauma	13 (52)
Sepsis	4 (16)
Acute myocardial infarction	1 (4)
Acute aortic dissection	1 (4)
Acute heart failure	1 (4)
Acute liver failure	1 (4)
Hypothermia	1 (4)
Crush syndrome	1 (4)
Neuromodulatory syncope	1 (4)
Anaphylaxis	1 (4)

Values are presented as number (%), mean±standard deviation, or number. The total number of medical histories entries exceeds 25 because each patient had multiple factors. Half of the cases were related to trauma, reflecting the location of the study.

SOFA: Sequential Organ Failure Assessment.

Table 2.

Summary of the measurements taken before and after the compression method

Variable	Before compression	After compression	P-value
Cross-sectional area (cm²)	0.4±0.3	1.0±0.3	<0.001
Anteroposterior diameter of the IJV (mm)	4.3±2.2	7.4±2.1	<0.001
transverse diameter of the IJV (mm)	11.3±4.9	17.0±4.8	<0.001

Values are presented as mean±standard deviation.

IJV: internal jugular vein.

REFERENCES

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2. Lamperti M, Biasucci DG, Disma N, Pittiruti M, Breschan C, Vailati D, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol 2020;37:344-76.Article PubMed
3. Vegas A, Wells B, Braum P, Denault A, Miller Hance WC, Kaufman C, et al. Guidelines for performing ultrasound-guided vascular cannulation: recommendations of the American Society of Echocardiography. J Am Soc Echocardiogr 2025;38:57-91.Article PubMed
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5. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 2015;1:CD006962.Article PubMed
6. Saugel B, Scheeren TW, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care 2017;21:225.Article PubMed PMC PDF
7. Kumar A, Bharti AK, Hussain M, Kumar S, Kumar A. Correlation of internal jugular vein and inferior vena cava collapsibility index with direct central venous pressure measurement in critically ill patients: an observational study. Indian J Crit Care Med 2024;28:595-600.Article PubMed PMC
8. Wang W, Liao X, Chen EC, Moore J, Baxter JS, Peters TM, et al. The effects of positioning on the volume/location of the internal jugular vein using 2-dimensional tracked ultrasound. J Cardiothorac Vasc Anesth 2020;34:920-5.Article PubMed
9. Garcia-Leal M, Guzman-Lopez S, Verdines-Perez AM, de Leon-Gutierrez H, Fernandez-Rodarte BA, Alvarez-Villalobos NA, et al. Trendelenburg position for internal jugular vein catheterization: a systematic review and meta-analysis. J Vasc Access 2023;24:338-47.Article PubMed PDF
10. Onal O, Apiliogullari S, Nayman A, Saltali A, Yilmaz H, Celik JB. The effectiveness of Trendelenburg positioning on the cross-sectional area of the right internal jugular vein in obese patients. Pak J Med Sci 2015;31:770-4.Article PubMed PMC
11. Chayapinun V, Koratala A, Assavapokee T. Seeing beneath the surface: harnessing point-of-care ultrasound for internal jugular vein evaluation. World J Cardiol 2024;16:73-9.Article PubMed PMC
12. Wang S, Cao X, Zhu P, Sun C, Cao L, Pei D. The effect of passive leg raising on the cross-sectional area of the right internal jugular vein in obese patients undergoing surgery: a prospective observational study. BMJ Open 2025;15:e098031. Article PubMed PMC
13. Gok F, Sarkilar G, Kilicaslan A, Yosunkaya A, Uzun ST. Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients. Int J Clin Exp Med 2015;8:19037-43.PubMed PMC
14. Xie S, Yu Q, Li T, Xu M, Wu J, Li Y. Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery. BMC Anesthesiol 2019;19:78.Article PubMed PMC PDF
15. Yang JL, Xie PC, Ma GP, Li ZF. The effect of increased abdominal pressure on internal jugular vein catheterization under ultrasound-guidance on conscious patients: a randomised controlled trial. Int J Surg 2020;77:183-6.Article PubMed
16. Stodtmeister R, Heyde M, Georgii S, Matthè E, Spoerl E, Pillunat LE. Retinal venous pressure is higher than the airway pressure and the intraocular pressure during the Valsalva manoeuvre. Acta Ophthalmol 2018;96:e68-73.Article PubMed PDF
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18. Nayman A, Onal IO, Apiliogullari S, Ozbek S, Saltali AO, Celik JB, et al. Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients. Ren Fail 2015;37:1280-4.Article PubMed
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Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan

Acute Crit Care. 2025;40(4):574-581. Published online November 24, 2025

DOI: https://doi.org/10.4266/acc.002025

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Figure

Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan

Figure 1. Flowchart of the study.

Figure 2. Demonstration of the ultrasound-guided supraclavicular internal jugular vein (IJV) compression method. (A) Demonstration of measurement using the custom-made ultrasound probe fixation device. The ultrasound probe is positioned at the puncture point of the IJV (device A) and remains fixed throughout the measurement by the custom-made ultrasound probe fixation device. The supraclavicular IJV is then compressed with another ultrasound transducer (device B). (B) Schematic of the ultrasound-guided supraclavicular IJV compression method. Compression of the IJV directly beneath device B creates a temporary occlusion (indicated by red arrows), blocking venous return and causing dilation of the IJV directly beneath device A (indicated by blue arrows). CCA: common carotid artery. CCA: common carotid artery.

Figure 3. Changes in the cross-sectional area (CSA) of the internal jugular vein (IJV) with the ultrasound-guided supraclavicular internal jugular vein compression method. P-values are calculated using paired t-test. The line graph shows the CSA of the puncture point of the IJV before and after applying the ultrasound-guided supraclavicular internal jugular vein compression method. The largest observed increase in vessel dimensions was from 0.1 cm2 to 1.2 cm2 in CSA. No cases of decreased CSA are reported.

Figure 4. Changes in the anteroposterior (A) and transverse (B) diameters of the internal jugular vein (IJV) when applying the ultrasound-guided supraclavicular IJV compression method. P-values are calculated by paired t-test. In both panels, no decreases were observed.

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan

Variable	Value (n=25)
Male sex	13 (52)
Age (yr)	71±14
Height (cm)	160.7±9.9
Weight (kg)	57.0±12.6
SOFA score	5.2±3.6
Medical history
Hypertension	9
Dyslipidemia	3
Diabetes	4
Malignant tumor	2
Cardiovascular disease	5
Cerebrovascular disease	5
Respiratory disease	2
Kidney and urologic diseases	4
Musculoskeletal disease	4
Gastrointestinal diseases	1
Mental disorders	3
Ophthalmic diseases	1
Reason for hospitalization
Trauma	13 (52)
Sepsis	4 (16)
Acute myocardial infarction	1 (4)
Acute aortic dissection	1 (4)
Acute heart failure	1 (4)
Acute liver failure	1 (4)
Hypothermia	1 (4)
Crush syndrome	1 (4)
Neuromodulatory syncope	1 (4)
Anaphylaxis	1 (4)

Variable	Before compression	After compression	P-value
Cross-sectional area (cm²)	0.4±0.3	1.0±0.3	<0.001
Anteroposterior diameter of the IJV (mm)	4.3±2.2	7.4±2.1	<0.001
transverse diameter of the IJV (mm)	11.3±4.9	17.0±4.8	<0.001

Table 1. Background characteristics of patients

SOFA: Sequential Organ Failure Assessment.

Table 2. Summary of the measurements taken before and after the compression method

Values are presented as mean±standard deviation.

IJV: internal jugular vein.