A Comparative Study of Right and Left IJV Cannulation Using Surface Anatomy or USG Guidance: A Prospective Randomized Study

Abstract

Background-Internal jugular vein cannulation (IJV) is a routinely done procedure in indicated patients. This procedure has been associated with many complications. We have assessed the utility of ultrasound in our hospital setup. Aims and objectives-To compare the success rate in right and left internal jugular vein cannulation using surface anatomy or ultrasound guidance. The time taken from initial puncture to successful insertion of guidewire was compared. The number of attempts and incidence of complications were also compared. Study design-A prospective randomized study in 106 patients from all patients indicated for internal jugular vein cannulation during the study period. Methods and materials-After approval from the ethics committee, consent was obtained for the study. 106 patients were randomly assigned into 4 groups-Group 1 right IJV cannulation using surface anatomy, Group 2-right IJV cannulation using USG guidance, Group 3 left IJV cannulation using surface anatomy, Group 4-left IJV cannulation using USG guidance. Data on time taken, number of attempts and incidence of associated complications was taken. Results-The mean time taken in group 1, group 2, group 3 and group 4 were 172.45213.60, 136.47122.86 seconds, 273.87127.59 seconds, and 135.25105.09 seconds respectively. There was no statistically significance between Group 1 and Group 2 (p value >0.05) and between Group 2 and Group 4(p value >0.05). There was a statistically significant difference (p value <0.001) between Group 3 and Group 4.The average attempts in group 1, group 2, group 3 and group 4 were 2.05 1.22, 1.46 0.64, 2.781.41, and 1.690.18 respectively. There was a difference in number of attempts between Group 1 and Group 2 and between Group 3 and Group 4that was statistically significant (p value <0.05, p value <0.01, respectively). But there was no statistically significance between Group 2 and Group 4(p value>0.05).Statistic evaluation of the incidences of carotid puncture shows no statistically significance between Group 1 (5.3%) and Group 2(nil) (p value>0.05) but there was statistical significance between Group 3(34.8%) and Group 4(nil) (p value <0.01) Conclusion-Ultrasound helps in safer successful cannulation of the internal jugular vein with lesser incidence of complications of carotid punctures especially for left sided internal jugular vein cannulations. Moreover, ultrasound guided internal jugular vein cannulation helps in reducing the average time duration