Internal Jugular Vein Cannulation: An Ultrasound-Guided Technique Versus a Landmark-Guided Technique

Abstract

OBJECTIVESTo compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients.METHODSA total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded.RESULTSThe overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups.CONCLUSIONThe findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications.

Comparison of US-Guided Catheterization of the Right Internal Jugular Vein Using Medial-Oblique and Short Axis Techniques

“…The average number of attempts was 1.25 in Group 1 (SAG) and 1 -1.5 in other investigations (8,11,12,16,17,19,21). The results also demonstrated no statistically significant difference between the two study groups concerning the mean number of attempts.…”

A Comparative Study between Two Central Venous Access Techniques Performed by Junior Residents

“…Many studies have confirmed that both landmark-guided CVA techniques are feasible and safe with similar complication rates [3,4,15], but the ultrasound-guided techniques have showed lower proportion of failures and complications rates [19,20]. Ultrasound-guided CVA is a helpful technique to gain CVAs [21] and the learning process of ultrasound-guided CVAs appears safe and feasible for training medical residents [16].…”

Ultrasound-guided internal jugular vein catheterization: comparative study with the conventional external anatomical landmarks technique

“…Por la técnica a través de parámetros anatómicos esta complicación es baja (1 al 2,4%) e incluso, estudios similares, (13,15,(18)(19) también reportan ausencia completa de esta complicación con el uso de guía ecográfica En relación a la medición del éxito se obtuvo un 100% en el grupo con ecografía y 94,6% en el grupo sin ecografía, resultando una diferencia sin significancia estadística. En contraste con estudios similares publicados, estos valores se encuentran acordes a otros reportes donde la efectividad va del (15,(20)(21)(22)(23)(24) 87% al 89% en el grupo sin guía ecográfica y del 97% al 100% con guía ecográfica En los tres casos de fracaso por parámetros anatómicos, la vía fue recolocada con éxito bajo guía ecográfica en un segundo tiempo, sin realizar registro de los mismos.…”

“…La localización de la vena es corroborada por la entrada de sangre de características propias (oscura, no pulsátil) que no eleva el émbolo por presión. Una vez localizada la vena se retira la jeringa y se realiza la primera punción con el (18) trocar en la misma dirección donde fue localizado el vaso previamente .…”

“…Se utiliza solución de iodopovidona o clorhexidina como medio para eliminar el aire en la superficie de contacto y para mejorar la calidad de la imagen. El operador toma con su mano no dominante el transductor y localiza nuevamente la vena yugular interna en el triángulo de Sedillot, procede a realizar anestesia local y posteriormente, bajo visión directa de pantalla en tiempo real, realiza la punción con el trocar comprobando en primera instancia la identación de la pared anterior de la vena y finalmente la entrada de sangre venosa en la luz del émbolo; a partir (16,18) de ese momento retira el transductor del sitio y continua con la técnica antes descrita .…”