Lateral oblique approach for internal jugular vein catheterization: Randomized comparison of oblique and short axis view of ultrasound-guided technique.

Abstract

U ltrasonography is recommended and has been found superior to the classic landmark technique for central venous catheterization [1, 2]. Agency for Healthcare Research and Quality report listed ultrasound (US) guidance for placement of central venous catheters (CVC) as one of the top patient safety practices and the use of the US during catheterization was recommended by the National Institute of Clinical Excellence since 2002 [3, 4]. Ultrasound-guided central venous catheter placement decreases complications and decreases catheter placement attempts [5]. Real-time two-dimensional ultrasound guidance was found in association with decreased risks of cannulation failure, arterial puncture, hematoma, and hemothorax, compared to the landmark technique [6]. There are many approaches and techniques for ultra-ABSTRACT OBJECTIVE: The lateral oblique approach is a novel needle-in-plane technique for ultrasound-guided catheterization of the internal jugular vein. In this study, we aimed to compare the oblique approach with the classical short-axis technique for facilitating the procedure and reduction of mechanical complications. METHODS: This research was planned as a prospective study. Eighty-four open-heart surgery patients requiring a central venous catheter were randomly allocated into two groups: Oblique approach group (n=42) and short-axis group (n=42). Time to cannulate, the number of necessary puncture attempts, and frequency of carotid artery puncture, hematoma, puncture site bleeding, pneumothorax, and hemothorax in each group were recorded. Visualization of the vein and the needle using ultrasound were also evaluated by a subjective scale. RESULTS: The patient's characteristics were comparable between the two groups. The mean time of catheterization was 52.00±70.18 seconds in the oblique approach group and 40.76±49.30 seconds in short-axis group. The mean number of needle puncture attempts was 1.21±0.61 in oblique approach and 1.12±0.50 in short-axis group. The results did not differ significantly. There was an improved visualization of the needle in the oblique approach group, but this was not proved as statistically significant. CONCLUSION: The results of our study suggest that the lateral oblique approach is a safe and effective technique, which can be a strong alternative to the classical short-axis technique for ultrasound-guided catheterization of the internal jugular vein.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided

“…The cost can further increase when the real-time technique is used as sterile ultrasound sleeves and jelly are used. This study showed no significant difference in terms of cannulation and complications, and we agreed with Ray et al that using the pre-location technique will decrease expenditures [ 20 ]. However, nothing much we can benefit from this technique if we compare it to real-time US guidance.…”

Modified combined short and long axis method versus oblique axis method in adult patients undergoing right internal jugular vein cannulation: A randomized controlled non-inferiority study

“…Finally, rotated the ultrasound probe 90°, then punctured IJV’s anterior wall using the long axis in-plane approach ( Fig 2A–2C ). Patients in the OA-IP group used the lateral oblique approach was described in the previous study [ 25 ]. Firstly, the ultrasound probe was placed parallelly to the clavicle to obtain a short-axis view of the CCA and IJV, and then the probe was rotated 45° clockwise to obtain CCA and IJV’s oblique-axis view.…”

Compare the Efficacy and Safety of Modified Combined Short and Long Axis Method versus Oblique Axis Method for Right Internal Jugular Vein Catheterization in Adult Patients (The MCSLOA Trial): Study Protocol of a Randomized Controlled Trial

“…Patients in the control group will receive right IJV catheterization using the lateral oblique approach described in the previous study (20). In this group, the ultrasound probe is placed on the jugular vein at mid-neck level to capture a transverse cross-sectional image of the CCA and IJV together.…”

“…The current clinical research is mainly about the comparative study of short axis method, long axis method, oblique axis method and modified methods of the above methods, in order to seek a safer and more effective ultrasound-guided IJV puncture method. A large number of studies have shown that the oblique axis method has obvious advantages compared to the long axis and the short axis methods, so it is recommended for internal jugular vein catheterization by many scholars (9,(16)(17)(18)(19)(20). In our previous research, we proposed a modified combined short and long axis method (MCSL) (11), which combines the advantages of the modified short axis out of plane approach (MSA-OOP) with the shortaxis combined long-axis method (CSLA) to accurately locate puncture needle points and visualize the entire needle body across the entire IJV catheterization (10,13).…”