Proximal penholding method – A variant to enhance safety of ultrasoundguided central venous cannulation: A prospective pilot study

Abstract

Aims:A significant incidence of Posterior Vessel Wall Puncture (PVWP) was reported during ultrasound guidance (USG) for internal jugular vein (IJV) catheterization. We studied a new technique of USGIJV cannulation to minimize or avoid PVWP, thereby decreasing overall complication rate, irrespective of the operators' experience level.Materials and Methods:After ethical approval, a prospective study was conducted on adult patients of either gender between 18–65 years of age, belonging to the American Society of Anesthesiologists Physical Status I–III, undergoing general anesthesia and requiring USG-guided IJV cannulation. After induction of general anesthesia and intubation, USG-guided IJV cannulation was done using technique of “proximal pen-holding method” in patients placed in supine position with neck rotated in 15° rotation to the opposite side. The primary outcome was defined as success rate of USG-guided IJV cannulation and incidence of PVWP. The secondary outcome was the incidences of complications such as arterial puncture, adjacent tissue damage, and performer's ease of the procedure (0–10 scale; 0 denoting no ease and extreme difficulty and 10 denoting extreme ease and no difficulty).Results:In 135 patients, right IJV puncture, guidewire, and central line insertion were achieved in single attempt without any PVWP by nine operators which included two anesthesia consultants and seven senior registrars. No complications were reported and ease of procedure were rated as median (interquartile range) of 10 (10).Conclusions:The “proximal pen-holding method” for real-time USG-IJV cannulation helped in avoiding PVWP with lesser complication rate and greater performer's ease.

Comparison of conventional needle holding technique and pen holding method of needle holding for real-time ultrasound-guided internal jugular venous cannulation – A randomised parallel-group study

“…described the novel technique of the pen holding method. [ 4 ] The authors suggested that holding the needle on the hub like a pen allows better control enabling precise movement, thereby avoiding overshooting of the needle and posterior wall puncture. Also, holding the needle like a pen is more familiar to the hand and helps estimate the skin thickness and texture and accurately estimate the pressure required for the puncture.…”

“…One of the techniques to avoid PVWP is the ‘proximal pen holding method’ of needle holding. [ 4 ] This study was aimed to compare the pen holding method of needle holding with the conventional needle holding technique for real-time USG-guided IJV catheterisation in short axis (SAX) view. The study’s primary objective was to compare the incidence of posterior vessel wall puncture between both the techniques.…”