Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients

Abstract

Objective: To investigate whether prepuncture ultrasound evaluation of vascular anatomy facilitates internal jugular vein cannulation compared with landmark-guided puncture. Design: Prospective randomized study. Setting: Single community hospital. Participants: Adult patients undergoing general anesthesia (n = 240). Interventions: The right internal jugular vein was cannulated using either anatomic landmarks or prepuncture ultrasound (3.75/7.5 MHz) guidance. In the landmark group, respiratory jugular venodilation was used as the primary landmark for locating the vein. Results of cannulation and the incidence of complications were compared. Measurements and Main Results: Patients were randomly assigned to the ultrasound or landmark group. Respiratory jugular venodilation was identified in 188 patients (78.3%), in whom results of cannulation did not differ between the 2 techniques with respect to the venous access rate (cannulated at the first attempt: 83.5% in the landmark v 85.7% in the ultrasound group), the success rate (cannulated within 3 attempts: 96.9% v 95.6%), and the incidence of arterial puncture (1.0% v 3.3%). In the remaining 52 respiratory jugular venodilation–unidentified patients, the access rate (30.4% v 86.2%, p < 0.001) and the success rate (78.3 v 100%, p < 0.05) were significantly better in the ultrasound group, and no arterial puncture was recorded in the ultrasound group, whereas the incidence was 13.0% in the landmark group. The results were similar regardless of the ultrasound frequency used. Conclusion: Prepuncture ultrasound evaluation did not improve the result of right internal jugular vein cannulation compared with the respiratory jugular venodilation–guided approach. When the landmark was not observed, however, the prepuncture ultrasound guidance was helpful in facilitating the cannulation. Copyright 2002, Elsevier Science (USA). All rights reserved.