Comparison of three different techniques for internal jugular vein cannulation under real time ultrasound guidance

Authors

  • Reena Mahajan Department of Anaesthesia, SHKM Government Medical College Nalhar, Mewat, Haryana, India
  • Suchitra Malhotra Department of Anaesthesia, SHKM Government Medical College Nalhar, Mewat, Haryana, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20211461

Keywords:

Technique, Axis, Vein, Cannulation

Abstract

Background: Ultrasound (USG) guided Internal jugular venous (IJV) cannulation is preferred than traditional approach due to increase in success rate, reduction in time taken and attempts of successful cannulation and less complications. The purpose of our study was to observe and compare three different real time 2-dimensional US-guided approaches and to determine which approach improves rate of successful cannulation, decreases complications along with shorter average time taken for the procedure. Primary outcomes of the study were venous access time, catheterization time and success rate. Secondary outcomes were number of patients requiring second attempt and complications observed.

Methods: 120 adult patients were randomly divided into three groups according to real time US guided cannulation done with SAX-OP approach, LAX-IP approach and OAX-IP approach. Parameters like venous access time, catheterization time, number of patients requiring second attempt and complications were noted.

Results: Venous access time was shortest in LAX group 21.84±3.67 seconds which was just significant statistically. Catheterization time was shortest in LAX group 241±123 seconds. Cannulation success rate was highest in LAX group 98% and was statistically significant. Patients requiring second attempt was least in LAX group 2.5%. Posterior IJV wall puncture was observed in 10% patients in SAX group and none in LAX and OAX group which was statistically significant.

Conclusions: LAX-IP showed better performance in terms of higher cannulation success, lesser average venous access time and catheterization time and lesser complications. On toggling USG probe, both IJV and carotid artery can be differentiated and carotid puncture could be avoided. Hence LAX approach is safer and effective approach.

References

Tammam TF, El-Shafey EM, Tammam HF. Ultrasound-guided internal jugular vein access: comparison between short axis and long axis techniques. Saudi J Kidney Dis Transpl. 2013;24(4):707-13.

Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24(12):2053-8.

Chittoodan S, Breen D, O'Donnell BD, Iohom G. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason. 2011;13(1):21-5.

Batllori M, Urra M, Uriarte E, Romero C, Pueyo J, López-Olaondo L et al. Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation. Br J Anaesth. 2016;116(3):370-6.

Hrics P, Wilber S, Blanda MP, Gallo U. Ultrasound-assisted internal jugular vein catheterization in the ED. Am J Emerg Med. 1998;16(4):401-3

National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing Central Venous Catheters. NICE Technology Appraisal Guidance No.49. London: NICE. 2002.

Ray BR, Mohan VK, Kashyap L, Shende D, Darlong VM, Pandey RK. Internal jugular vein cannulation: A comparison of three techniques. J Anaesthesiol Clin Pharmacol. 2013;29(3):367-71.

Shrestha GS, Gurung A, Koirala S. Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein. Ann Card Anaesth. 2016;19(2):288-92.

Chittoodan S, Breen D, O'Donnell BD, Iohom G. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason. 2011;13(1):21-5.

Chaudhari MS, Shah SB, Kamat HV. Ultrasound guided internal jugular vein cannulation with short and long axis approach. Technical ease and complications. Indian J Clin Anaesth. 2016;3:546-50.

Caffery T, Jagneaux T, Jones GN, Stopa E, Freeman N, Quin CC et al Residents' Preferences and Performance of Three Techniques for Ultrasound-Guided Central Venous Cannulation After Simulation Training. Ochsner J. 2018;18(2):146-150.

Vogel JA, Haukoos JS, Erickson CL, Liao MM, Theoret J, Sanz GE, Kendall J. Is long-axis view superior to short-axis view in ultrasound-guided central venous catheterization? Crit Care Med. 2015;43(4):832-9.

Balaban O, Aydin T, Musmul A. Lateral oblique approach for internal jugular vein catheterization: Randomized comparison of oblique and short-axis view of ultrasound-guided technique. North Clin Istanb. 2019;7(1):11-7.

Downloads

Published

2021-04-22

Issue

Section

Original Research Articles