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Abstract
The aim of this study is to find out if an ultrasound technique has advantages over the conventional landmark technique. This is a prospective randomized comparative study on 120 patients requiring central venous cannulation of the right internal jugular vein. The study comprised of two groups: ultrasound and landmark groups, each consisting of 60 patients. The outcome measures were compared between the groups. Cannulation of the internal jugular vein was successful in 58 patients in the ultrasound group and in 53 in the landmark group. The number of attempts was 1.5 (1 - 3) and 2 (1 - 3) in the ultrasound and landmark group respectively (p = 0.001). The time taken for the successful cannulation was 4.9 +/- 1.7 minutes in the ultrasound approach and 8.0 +/- 2.8 minutes in the landmark approach (p = 0.00). The internal jugular vein diameter in the supine position was 11.2 +/- 1.5 mm which increased to 15.04 +/- 1.5 mm with a 15 degrees head-down position in the USG group (p = 0.001). The first attempt success rate was 39/60 (63%) in the ultrasound group and 19/60 (32%) with the landmark technique. The seven (12%) failure cases in the landmark group were rescued by the ultrasound technique. Inadvertent carotid artery puncture occurred in 2/60 (3%) and 6/60 (10%) of patients in the ultrasound and land mark group respectively. Ultrasound improves success rate, minimizes cannulation time and complications during internal jugular vein cannulation. It can be employed as a rescue technique in cases of a failed landmark technique.
Highlights
Placement of a central venous catheter remains a common procedure during the management of patients in the intensive and critical care units
The landmark technique is still the method of choice for central venous cannulation (CVC) in our context due to reasons including an unavailability of equipments and a lack of training facility
The internal jugular vein (IJV) diameter in the supine position was 11.2 ± 1.5 mm which increased to 15.04 ± 1.5 mm with a 15 degrees head-down position in the USG group (p = 0.001 )
Summary
Placement of a central venous catheter remains a common procedure during the management of patients in the intensive and critical care units. The external landmark method is still the technique of choice in many critical care units. The landmark technique is still the method of choice for central venous cannulation (CVC) in our context due to reasons including an unavailability of equipments and a lack of training facility. Abundant clinical reports emerged in the literature showing the efscacy and safety of this procedure over the traditional one Recognizing this fact, the National Institute of Clinical Excellence in the United Kingdom has recommended the use of USG guidance for CVC as one of the mandatory practices to improve patient care.[2] Ultrasound has become an integral tool for high precision CVC, providing a rapid procedure as well as less complication in the ICUs
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