Comparison of the landmark technique and the static ultrasound-guided technique for internal jugular vein cannulation in adult cardiac surgical patients

Abstract

Background: The use of real time ultrasound (US) for insertion of central venous catheters is limited by various factors such as availability, space constraints, and perceived lack of need according to surveys including cardiovascular anesthesiologists. Methods: After the ethical committee approval and patient consent, 201 adult patients scheduled for elective cardiac surgery were randomized to undergo internal jugular vein (IJV) cannulation by either of the two methods: Landmark technique (control group), static US technique using the transthoracic echocardiography (TTE) probe (US group). The success rate, number of attempts, total cannulation time, and complication rate in the two groups were compared. Results: The overall success rate and the first attempt success rate were significantly higher in the control group than the US group (99% vs. 89.6%, P = 0.003 and 87.6% vs. 70.8%, P = 0.003, respectively). The total number of attempts to locate the IJV with the finder needle as well as the puncture needle was significantly lower in the control group than the US group (2.2 vs. 1.3, P = 0.001and 1.7 vs. 1.2, P = 0.021, respectively). The incidence of arterial puncture was higher in the US group than the control group (9.4% vs. 1.9%, P= 0.020). The total cannulation time was also higher in the US group (430 ± 320 s) than the control group (197 ± 116 s, P= 0.001). Conclusion: The landmark technique has a higher success rate, lower complication rate, and total cannulation time as compared with the static US technique using the TTE probe for IJV cannulation in adult cardiac surgical patients.