A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting

Abstract

Background and Objectives:Central venous catheter placement is a frequently performed procedure in emergency medicine as well as critical care unit. We aimed to compare real-time ultrasonography (USG)-guided and the traditional anatomical landmark (AL) technique for the insertion of internal jugular vein (IJV) catheters in an emergency department (ED) setting.Materials and Methods:Patients requiring IJV catheterization were prospectively recruited over a period of 1 year at a single center. Cannulation was done either by the AL or USG technique, according to ED physician's discretion. A preset pro forma was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the nonparametric Mann–Whitney U-test.Results and Discussion:Seventy patients were enrolled, of which 35 patients underwent IJV cannulation by USG-guided technique (USG group) and 35 patients by the AL technique (AL group). There were a 100% success rate (35/35) for cannulation in the USG group and a 91.4% success rate (32/35) in the AL group. The catheter was placed on the first attempt in 17 (48.6%) patients in the AL group and 32 (91.4%) patients in the USG group. In th AL group, there were three failed cannulation attempts in comparison to the USG group. The mean start to flash time for the AL technique was 16.59 s (±10.67) and 4.86 s (±2.18) in the USG group. The mean cannulation time was 305.88 s (±66.84) in the AL group and 293.03 s (±71.15) in the USG group. A total of seven acute complications were noted, of which 2 (5.7%) in the USG group and 5 (14.3%) in the AL group.Conclusion:The real-time USG guided technique significantly reduces the number of attempts to cannulate, has a higher first-pass success rate, a quicker flash time, and fewer complications when compared to the AL technique. In EDs equipped with USG, insertion of IJV catheters under real-time USG guidance should become the standard of care.

Internal jugular vein catheterization: A comparison between ultrasound guided technique with landmark guided technique

“…The right IJV is usually preferred because superior venacava can be reached directly from the right avoiding injuries to the ductus thoracicus. 5 It is the first choice in patients with coagulopathy. Traditionally IJV cannulation was done by palpation and using anatomical landmarks.…”

Ultrasound assisted catheterization of internal jugular vein

“…Verimli bir hemodiyaliz için travmatize edilmemiş ve komplikasyon gelişmemiş geniş bir vasküler yola ihtiyaç vardır. Yapılan birçok çalışma da İJV kateterizasyonunun USG eşliğinde yapılmasının başarılı, güvenli, kolay ve hızlı uygulanan bir yöntem olduğunu bildirilmektedir (5)(6)(7). Klasik olarak santral ven kateterizasyonu anatomik bilgi ve vene yakın arterin palpasyonu ile sağlanmaktadır.…”

Real‐time ultrasound‐guided internal jugular vein cannulation by oblique‐axis in‐plane: Practice at the Fourth Hospital of Hebei Medical University

“…To improve success, ultrasound has been recommended since the 1980s to guide the procedure, 4 and ultrasound‐guided IJV cannulation has shown improved success rates and significantly reduced complications 1,5 . Numerous studies have shown that the real‐time ultrasound‐guided technique significantly reduces the number of attempts to cannulate, a higher first‐pass success rate, quicker cannulation time and fewer complications compared with the conventional anatomical landmark technique 6‐9 …”

“…Various techniques for ultrasound probe position and the needle approach have been described to improve success rate and minimise complications 6‐9 . Batllori et al 10 performed a randomised comparison of three transducer orientation approaches for ultrasound‐guided IJV cannulation in 220 patients.…”