Current practice of internal jugular venous cannulation in a university anesthesia department: Influence of operator experience on success of cannulation and arterial injury

Abstract

Objective: To describe current cannulation of the internal jugular vein (CIJV) practice in a university anesthesia department. Design: Prospective, observational, and not randomized. Setting: Operating rooms of the Hospital of the University of Pennsylvania. Participants: Elective surgical patients requiring CIJV (n = 426). Interventions: CIJV performed by real-time ultrasound visualization (U-CIJV) or by anatomic landmarks (AL-CIJV). Measurements and Main Results: A total of 462 procedures were studied in 426 patients. Overall cannulation failure was 2.1% with U-CIJV and 13.8% with AL-CIJV (p = 0.0001). Cumulative CIJV success by the sixth needle pass was 94.0%, regardless of technique. Junior operators performed 75.3% of CIJV, of which 86.8% was U-CIJV. First-pass success across operators was 60% to 70% for U-CIJV and 50% to 80% for AL-CIJV. Arterial puncture rates averaged 7.0%, regardless of technique (p = 0.45). The junior operator may be more at risk for arterial puncture during U-CIJV. Conclusion: U-CIJV offers incomplete protection against arterial injury in this practice compared with the literature. A possible solution is the ultrasound needle guide, which may minimize arterial injury, especially with junior operators. Copyright 2002, Elsevier Science (USA). All rights reserved.