Comparing short‐axis versus long‐axis ultrasound‐guided techniques for internal jugular vein cannulation: A meta‐analysis of clinical outcomes and safety

Abstract

IntroductionCentral venous access plays a crucial role in various clinical settings, and ultrasound guidance has become increasingly popular for improving its safety and success rates. The aim of this meta‐analysis was to compare the short‐axis (SAX) and long‐axis (LAX) ultrasound‐guided techniques for internal jugular vein (IJV) cannulation in terms of first needle pass success rate, number of cannulation attempts, access time, guidewire insertion time, posterior IJV wall puncture, arterial puncture, haematoma and catheter‐related bloodstream infection.MethodsA comprehensive literature search was conducted, and randomised controlled trials (RCTs) comparing SAX and LAX techniques for IJV cannulation on adults were included.ResultsA total of 11 RCTs involving 1183 patients were included in the meta‐analysis. The SAX technique demonstrated a significantly greater first needle pass success rate and faster IJV access time compared to the LAX technique. However, more posterior IJV wall puncture was significantly associated with the SAX technique. There was no significant difference between the two techniques in terms of number of cannulation attempts, guidewire insertion time, arterial puncture, haematoma and catheter‐related bloodstream infection.ConclusionThis meta‐analysis suggests that the SAX technique may have advantages over the LAX technique in terms of first needle pass success rate and potentially reducing cannulation attempts and access time. However, the occurrence of posterior IJV wall puncture raises concerns. The decision on the choice of technique should be based on individual patient factors and operator proficiency.

A Randomized Study Comparing Ultrasound-Guided Internal Jugular Vein Cannulation Using Two Techniques: Short-Axis Out-of-Plane With Dynamic Needle Tip Positioning Versus Long-Axis In-Plane

“…The precise identification of the midpoint of the IJV on the DNTP view as compared with the LAIP view may have attributed to this clinical benefit. AlGhamdi et al [18], in their study comparing short-axis versus long-axis ultrasound-guided techniques for IJV cannulation, reported the short-axis view to be advantageous over the long-axis view in terms of the first needle pass.…”