Comparison of conventional needle holding technique and pen holding method of needle holding for real-time ultrasound-guided internal jugular venous cannulation - A randomised parallel-group study.

Abstract

Ultrasound-guided central venous (CV) cannulation is the standard of care for inserting CV catheter in the right internal jugular vein (RIJV). However, mechanical complications can still occur. The primary objective of this study was to compare the incidence of posterior vessel wall puncture (PVWP) using conventional needle holding technique with pen holding method of needle holding technique for IJV cannulation. Secondary objectives were comparison of other mechanical complications, access time and ease of the procedure. This prospective, randomised parallel-group study included 90 patients. Patients requiring ultrasound-guided RIJV cannulation under general anaesthesia were randomised into two groups P (n = 45) and C (n = 45). In group C, the RIJV was cannulated using the conventional needle holding technique. In group P, the pen holding method of needle holding technique was used. Incidence of PVWP, complications (arterial puncture, haematoma) number of attempts for successful cannulation, time to insertion of guidewire and performer's ease were compared. The data were analysed using Statistical Package for the Social Sciences (SPSS version 24.0). A P value less than 0.05 was considered statistically significant. In our study, there was no significant difference in incidence of PVWP and complications between the two groups. Number of attempts and time for successful guidewire insertion were comparable. Ease of the procedure was scored a median of 10 in both the groups. There was no significant difference in the incidence of PVWP between the two techniques in this study, necessitating further evaluation of this novel technique.