Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Abstract

Background: Ultrasound-guided internal jugular venous access increases the rate of successful cannulation and reduces the incidence of complications, compared with the landmark technique. Three transducer orientation approaches have been proposed for this procedure: short-axis (SAX), long-axis (LAX) and oblique-axis (OAX). Our goal was to assess and compare the performance of these approaches. Methods: A prospective randomized clinical trial was conducted in one teaching hospital. Patients aged 18 yr or above, who were undergoing ultrasound-guided internal jugular cannulation, were randomly assigned to one of three intervention groups: SAX, LAX and OAX group. The main outcome measure was successful cannulation on first needle pass. Incidence of mechanical complications was also registered. Restricted randomization was computer-generated. Results: In total, 220 patients were analysed (SAX n=73, LAX n=75, OAX n=72). Cannulation was successful on first needle pass in 51 (69.9%) SAX patients, 39 (52%) LAX patients and 53 (73.6%) OAX patients. First needle pass failure was higher in the LAX group than in the OAX group (adjusted OR 3.7, 95% CI 1.71-8.0, P=0.002). A higher mechanical complication rate was observed in the SAX group (15.1%) than in the OAX (6.9%) and LAX (4%) groups (P=0.047). Conclusions: As OAX showed a higher first needle pass success rate than LAX and a lower mechanical complications rate than SAX, we recommend it as the standard approach when performing ultrasound-guided internal jugular venous access. Further clinical studies are needed to confirm this conclusion.

Evaluating the Long‐, Short‐, and Oblique‐Axis Approaches for Ultrasound‐Guided Vascular Access Cannulation

“…After duplicated literature search results were excluded, and the topics and abstracts of the articles were examined, we reviewed the full texts of 20 articles. Ultimately, 7 publications that involved 802 participants were included in our analyses (Table ).…”

“…Seven trials reported information on the first‐pass success rate and were included in this meta‐analysis (Figure , Table ). We chose a random‐effects model to evaluate the RRs for overall effect size for the 3 examined techniques.…”

“…Five of the included studies reported mean time to success (Figure ) and mean attempts until success (Figure ) as secondary outcomes. We chose a random‐effects model to evaluate mean differences in the overall effect sizes for the 3 techniques.…”

“…SAX allows simultaneous visualization of both the target vessel and nontarget vessel but can make needle tip control difficult. OAX attempts to take advantage of 2 previous methods using a probe alignment between SAX and LAX, and in conjunction with in‐plane needle insertion where the needle advances from the side to the inside Thus, OAX optimizes the visualization of the needle and target blood vessels as well as all their surrounding structures …”

Techniques, Advantages, and Pitfalls of Ultrasound-Guided Internal Jugular Cannulation: A Qualitative Study

“…25,[34][35][36][37] Unfortunately the in-plane ultrasound technique is technically demanding and a change to this technique may represent an unrealistic expectation given the training burden it would represent. 38 The pragmatic recommendation is therefore to ensure that training in internal jugular cannulation does not present ultrasound-guidance as a panacea, but recognises and attempts to mitigate the potential for harm when using this technology in different ways.…”