Ultrasound-guided internal jugular vein access: Comparison between short axis and long axis techniques

Abstract

The use of real-time ultrasound (US) is advantageous in the insertion of central venous catheters (CVCs) in adults, especially in whom difficulties are anticipated for various reasons. The aim of the present study was to compare two different real-time 2-dimensional US-guided techniques [short axis view/out-of-plane approach (SAX OOP approach) versus long axis view/in-plane approach (LAX IP approach)] for internal jugular vein (IJV) cannulation. In this prospective study, 90 critical care and hemodialysis patients were assigned for insertion of CVCs using either the real-time US-guided (SAX OOP approach or LAX IP approach) or landmark technique (control group). Failed catheter placement, risk of complications from placement, failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization, incidence of central line-associated blood stream infection (CLA-BSI) and demographics of each patient were recorded. There were no significant differences in patient's demographic characteristics, side of cannulation (right or left) or presence of risk factors for difficult venous cannulation between the three groups of patients. Cannulation of the IJV was achieved in all patients by using US (SAX OOP and LAX IP approaches) and in 27 of the patients (90%) by using the landmark technique (P = 0.045). Average access time (skin to vein) and number of attempts were comparable between the SAX OOP and the LAX IP approaches while significantly reduced in both US groups of patients compared with the landmark group (P <0.001). In the landmark group, puncture of the carotid artery occurred in 16.7% of the patients, hematoma in 23.3% of the patients, pneumothorax in 3.3% of the patients and CLA-BSI in 20% of the patients, which were all significantly increased compared with the US group (P <0.05). The findings of this study suggest that the SAX OOP and LAX IP approaches were comparable for cannulation of IJV in critical care and hemodialysis patients. Furthermore, both US-guided techniques were superior to the landmark technique for insertion of CVCs.

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

“…In human studies, Chittoodan et al demonstrated higher first-pass success and fewer needle redirections in the short-axis group (among experienced) as compared to the long-axis approach and comparable procedure time in both groups [15]. Tammam et al found no significant difference between the short-axis and long-axis approaches [16].…”

Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine

“…69 A prospective, three-arm study comparing ultrasound-guided long-axis, short-axis, and landmark-based approaches showed a CLABSI rate of 20% in the landmark-based group versus 10% in each of the ultrasound groups. 57 Another randomized study comparing use of ultrasound guidance to a landmark-based technique for IJV CVC insertion demonstrated significantly lower CLABSI rates with the use of ultrasound (2% vs 10%; P < .05). 72 Studies have shown that a systems-based intervention featuring a standardized catheter kit or catheter bundle significantly reduced CLABSI rates.…”

“…The incidence of carotid puncture and hematoma was significantly higher with the landmark-based approach versus either the long-or short-axis ultrasound approach (carotid puncture 17% vs 3%, P = .024; hematoma 23% vs 3%, P = .003). 57 High success rates have been reported using a short-axis approach for insertion of PIV lines. 58 A prospective, randomized trial compared the short-axis and long-axis approach in patients who had had ≥2 failed PIV insertion attempts.…”

Idiopathic unilateral hypoplasia of internal jugular vein and coagulopathy: Unusual case for central venous catheterization

“…arterial puncture and hematoma occurred in as high as 16.7% and 23.3% of cases, respectively. [ 4 5 ] Arterial puncture in patients who has altered coagulation profile could be a potentially very serious complication.…”

“…Ultrasound (US)-guided techniques found to be safer and less time consuming than anatomic landmark technique. [ 4 5 ] We report a case of idiopathic unilateral hypoplastic IJV in a patient with altered coagulation profile, in whom CVC was performed successfully using the US-guided technique.…”