Posterior Wall Puncture Research Articles

Ultrasound Guided Internal Jugular Vein Acesss: Comparison Between Short Axis And Long Axis Technique

Abstract Background: Percutaneous techniques have transformed vascular cannulation. It has reduced the need for open procedures and the associatedwoundcomplications, but percutaneous techniques have made physicians dependent on relationships between surface anatomic landmarks and deep anatomic structures. Now, percutaneous central venous catheter insertion by physicians has a lesser complication rate. During central venous catheterization, the complications include infection, occlusion, thrombosis and mechanical complications. Aims and Objective: To relate the inner course of cannulating needle, familiarity of surface anatomic landmarks excludes the complication. Deep anatomic relationships visualization does not only improves the efficacy and safety of the procedure but also supplements the operator’s ability to identify difficult cannulations. The safety of internal jugular cannulations increases with ultrasound visualization. Central venous cathetrization (CVC) is done for hemodynamic monitoring (such as central venous pressure) long-term administration of fluids, antibiotics, total parental nutrition, and hemodialysis. Material and Methods: Most commonly, the internal jugular vein (IJV) is cannulated because of its relatively less complications and easy accessibility. Seldinger technique is used for IJV cannulation. Landmark-guided IJV cannulation is associated with a more number of complications compared to ultrasound-guided cannulation. Ultrasound-guided cannulation improves success rate, reduces the number of needle passes, and decreases complications. Two different real-time ultrasound-guided cannulations of IJV using a short axis/out-of-plane (SA) approach and a long axis/in plane (LA) approach are compared in the study. Hence, the present study was done at our tertiary care center to compare ultrasound-guided IJV access between SA and LA technique method with the number of attempts and complications. Results: It was observed in the present study that 4 (10%) patients in Long axis group had posterior wall puncture while 9 (22.5%) patients in short axis group had posterior wall puncture. Conclusion: Posterior wall puncture incidence is lesser in long axis group than short axis group.

Comparing short-axis versus long-axis ultrasound-guided techniques for internal jugular vein cannulation: A meta-analysis of clinical outcomes and safety.

Central venous access plays a crucial role in various clinical settings, and ultrasound guidance has become increasingly popular for improving its safety and success rates. The aim of this meta-analysis was to compare the short-axis (SAX) and long-axis (LAX) ultrasound-guided techniques for internal jugular vein (IJV) cannulation in terms of first needle pass success rate, number of cannulation attempts, access time, guidewire insertion time, posterior IJV wall puncture, arterial puncture, haematoma and catheter-related bloodstream infection. A comprehensive literature search was conducted, and randomised controlled trials (RCTs) comparing SAX and LAX techniques for IJV cannulation on adults were included. A total of 11 RCTs involving 1183 patients were included in the meta-analysis. The SAX technique demonstrated a significantly greater first needle pass success rate and faster IJV access time compared to the LAX technique. However, more posterior IJV wall puncture was significantly associated with the SAX technique. There was no significant difference between the two techniques in terms of number of cannulation attempts, guidewire insertion time, arterial puncture, haematoma and catheter-related bloodstream infection. This meta-analysis suggests that the SAX technique may have advantages over the LAX technique in terms of first needle pass success rate and potentially reducing cannulation attempts and access time. However, the occurrence of posterior IJV wall puncture raises concerns. The decision on the choice of technique should be based on individual patient factors and operator proficiency.

Comparison of the scan-as-you-go technique with the short-axis out-of-plane technique on the incidence of posterior venous wall puncture in ultrasound-guided internal jugular vein cannulation - A randomised controlled trial.

Comparison of the scan-as-you-go technique with the short-axis out-of-plane technique on the incidence of posterior venous wall puncture in ultrasound-guided internal jugular vein cannulation - A randomised controlled trial.

Internal jugular access using pocket ultrasound in a simulated model: comparison between biplane and monoplane visualization techniques

IntroductionUltrasound is the current standard for central venous access due to its advantages in efficiency and safety. In-plane and out-of-plane visualization techniques are commonly used, but there is no clear evidence showing an advantage of one technique over the other. The objective of this study was to compare the success and time required for biplane visualization vs. in-plane and out-of-plane techniques in simulated models.MethodologyTen emergency medicine specialists participated in 60 simulated events, with randomization of the visualization technique for each event. Each event required intravenous cannulation of a simulated model for jugular venous access, with a maximum of three attempts allowed. The number of attempts required for each event, success of puncture and venous cannulation, frequency of redirection and puncture of the posterior wall, time required to obtain an optimal window, visualize the needle inside the vessel, and passage of the guidewire were recorded. The success ratios and times required for each visualization technique (biplane, in-plane, and out-of-plane) were compared.ResultsCannulation success rate was 100% for all three techniques. Success on the first attempt was 95% for biplane visualization vs. 100% for in-plane and out-of-plane. The median total time for the procedure was higher for biplane visualization (29.9 s) compared to in-plane (25.2 s) and out-of-plane (29 s), but this difference was not statistically significant (p = 0.999). There were no significant differences in cannulation success, needle redirection, or posterior wall puncture frequency between biplane visualization and in-plane and out-of-plane techniques.ConclusionsThis study suggests that biplane visualization with the use of pocket ultrasound for internal jugular cannulation in simulated models did not demonstrate significant differences when compared with in-plane and out-of-plane visualization techniques. Further research with larger sample sizes may be needed to confirm these results.

Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review

BackgroundThe two most common methods for ultrasound-guided arterial cannulation are the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches. However, it is uncertain which method is more advantageous. We conducted a meta-analysis of reported randomized clinical trials (RCTs) comparing the two techniques in terms of success rate, cannulation time, and complications.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library database for RCTs comparing the LA-IP and SA-OOP techniques for ultrasound-guided arterial cannulation published from inception through April 31, 2022. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Review Manager 5.4 and Stata/SE 17.0 were used to analyze the two primary outcome measures (first-attempt success rate and total success rate) and two secondary outcome measures (cannulation time and complications).ResultsA total of 13 RCTs with 1,377 patients were included. There were no significant differences in first-attempt success rate (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.78–1.12; P = 0.45; I2 = 84%) and overall success rate (RR, 0.99; 95% CI, 0.95–1.02; P = 0.48; I2 = 57%). When compared with the LA-IP technique, the SA-OOP technique was associated with an increased incidence of posterior wall puncture (RR, 3.01; 95% CI, 1.27–7.14; P = 0.01; I2 = 79%) and hematoma (RR, 2.15; 95% CI, 1.05–4.37; P = 0.04; I2 = 63%). There was no significant difference in the incidence of vasospasm between techniques (RR, 1.26; 95% CI, 0.37–4.23; P = 0.07; I2 = 53%).ConclusionsThe present results suggest that the SA-OOP technique is associated with a higher incidence of posterior wall puncture and hematoma than the LA-IP technique, whereas success rates are similar for the two ultrasound-guided arterial cannulation techniques. These findings should be experimentally evaluated in a more rigorous manner due to high inter-RCT heterogeneity.

Biplanar versus conventional two-dimensional ultrasound guidance for radial artery catheterisation.

Ultrasound guidance increases first-pass success rates and decreases the number of cannulation attempts and complications during radial artery catheterisation but it is debatable whether short-, long-, or oblique-axis imaging is superior for obtaining access. Three-dimensional (3D) biplanar ultrasound combines both short- and long-axis views with their respective benefits. This study aimed to determine whether biplanar imaging would improve the accuracy of radial artery catheterisation compared with conventional 2D imaging. This before-and-after trial included adult patients who required radial artery catheterisation for elective cardiothoracic surgery. The participating anaesthesiologists were experienced in 2D and biplanar ultrasound-guided vascular access. The primary endpoint was successful catheterisation in one skin break without withdrawals. Secondary endpoints were the numbers of punctures and withdrawals, scanning and procedure times, needle visibility, perceived mental effort of the operator, and posterior wall puncture or other mechanical complications. From November 2021 until April 2022, 158 patients were included and analysed (2D=75, biplanar=83), with two failures to catheterise in each group. First-pass success without needle redirections was 58.7% in the 2D group and 60.2% in the biplanar group (difference=1.6%; 95% confidence interval [CI], -14.0%-17.1%; P=0.84), and first-pass success within one skin break was 77.3% in the 2D group vs 81.9% in the biplanar group (difference=4.6%; 95% CI, 8.1%-17.3%; P=0.473). None of the secondary endpoints differed significantly. Biplanar ultrasound guidance did not improve success rates nor other performance measures of radial artery catheterisation. The additional visual information acquired with biplanar imaging did not offer any benefit. N9687 (Dutch Trial Register).

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.

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.

Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients.

Background: During internal jugular vein (IJV) cannulation, needle tip injury to vulnerable subjacent cervical anatomic structures can be prevented if the cannulating needle tip is not permitted, even momentarily, to penetrate the deep portion of the IJV wall, an event known as double-wall puncture (DWP), also called posterior wall puncture. Methods: We conducted a 6-year ultrasound-guided IJV cannulation quality improvement project, seeking to minimize the occurrence of DWP in 228 adult patients using needles of different gauge and tip sharpness. Most needles were length-optimized to the distance between the skin puncture site and the IJV mid-lumen for a selected angle of needle insertion by (1) using a nylon screw-on needle stop or (2) using a cannulating needle that already had the desired shaft length. Results: Standard central venous cannulation kit needles were long enough to reach or traverse the deepest portion of the IJV wall in nearly all patients. Use of extra-sharp, smaller-diameter needles in place of standard needles was associated with a 26.3% relative reduction in DWP rate. Use of needles length-optimized to reach only the IJV mid-lumen was associated with a 78.4% relative reduction in DWP rate. A 0% DWP rate was attained using length-optimized 21-gauge extra-sharp needles and length-optimized 20-gauge needles of intermediate sharpness. Conclusion: The 9.2% DWP rate achieved during this project was approximately half the rate reported at the time of project inception. Use of length-optimized, sharper, narrower-gauge cannulating needles may help avoid DWP during ultrasound-guided IJV cannulation.

Ultrasound-Guided Dynamic Needle-Tip Positioning Method Is Superior to Conventional Palpation and Ultrasound Method in Arterial Catheterization.

Background: Dynamic needle-tip positioning (DNTP) was shown to improve arterial cannulation efficiency with fewer complications than conventional palpation and ultrasound methods by some studies. However, this is still controversial, and we performed this meta-analysis to comprehensively assess its value in arterial cannulation. Methods: A literature search of randomized controlled trials was conducted, and 11 studies were finally included. Efficiency outcomes (first-attempt success, overall success, and total cannulation time) and complications (hematoma, thrombosis, posterior wall puncture, and vasospasm) were separately analyzed. Subgroup analyses in different populations under cannulation were also performed. Results: DNTP was associated with increased first-attempt success (pooled RR = 1.792, p < 0.001), overall success (pooled RR = 1.368, p = 0.001), and decreased cannulation time (pooled SMD = −1.758, p = 0.001) than palpation. DNTP gained even more advantage in small children and infants. No significant difference in these outcomes between DNTP and conventional ultrasound method was detected. Fewer hematoma occurred in DNTP than palpation (pooled RR = 0.265, p < 0.001) or traditional ultrasound (pooled RR = 0.348, p < 0.001). DNPT was also associated with fewer posterior wall punctures (pooled RR = 0.495, p = 0.001) and vasospasm (pooled RR = 0.267, p = 0.007) than traditional ultrasound. Conclusions: DNTP was a better choice in artery cannulation than conventional palpation and ultrasound method, especially in small children and infants.

Compare the Efficacy and Safety of Modified Combined Short and Long Axis Method versus Oblique Axis Method for Right Internal Jugular Vein Catheterization in Adult Patients (The MCSLOA Trial): Study Protocol of a Randomized Controlled Trial.

BackgroundUltrasound-guided internal jugular vein (IJV) catheterization has become a standard procedure as it yields a higher success rate and fewer mechanical complications compared with an anatomical landmark technique. There are several common methods for ultrasound guidance IJV catheterization, such as short-axis out-of-plane, long-axis in-plane and oblique axis in-plane, but these technologies are still developing. It is important to further study the application of different ultrasound-guided IJV puncture techniques and find an effective and safe ultrasound-guided puncture technique.MethodsA China randomized, open-label, parallel, single center, positive-controlled, non-inferiority clinical trial will evaluate 190 adult patients undergoing elective surgery and need right jugular vein catheterization. Study participants randomized in a 1:1 ratio into control and experimental groups. The control group will take the oblique axis in-plane method for IJV catheterization. The experimental group will take the Modified combined short and long axis method. The primary endpoint of the trial is the rate of one-time successful guidewire insertion without posterior wall puncture (PWP). Secondary endpoints are the number of needle insertion attempts, the total success rate, the procedure time, and mechanical complications.ConclusionThis randomized controlled trial will evaluate the effectiveness and safety of Modified combined short and long axis method and oblique axis in-plane method for right IJV catheterization in adult patients.

Effect of side guide marks of ultrasound transducer on the success rate of ultrasound transducer-guided radial artery puncture: A randomized trial.

Compared with blind technique, ultrasound (US) transducer-guided technique for radial artery puncture can improve the success rate. However, difficulty in handling US transducer-guided technology is a key limitation to its wider use. The aim of the study was to explore the effect of guide marks on the side of US transducer on the success rate of US transducer-guided radial artery puncture. In this parallel-group trial, 127 patients undergoing elective liver cancer resection and splenectomy under general anesthesia were randomly allocated to the traditional group or the Intervention group. The traditional group used the conventional US transducer-guided radial artery puncture technology, while the Intervention group used the US transducer-guided radial artery puncture technology with the guide marks on the side of the US transducer probe. The primary observation index was success rate of radial artery cannulation at the first attempt; the secondary observation indices were failure rate of cannulation, location time, and total time for successful cannulation. The successful rate of cannulation in the Intervention group (59 out of 63, 93.6%) was greater than that in the traditional group (50 out of 64, 78.1%, p = 0.01). The posterior wall puncture rate in the Intervention group was lower than that in the traditional group (11.1% vs 32.8%, p = 0.005). The location time in the Intervention group was longer than that in the traditional group (20.1 ± 3.8 vs 16.6 ± 4.0 s, p < .001), while the total cannulation time was significantly shorter (20.7 ± 4.3 vs 32.4 ± 7.4 s, p < 0.001). Using guide marks on the side of US transducer can help improve success rate of US transducer-guided radial artery puncture at the first attempt and reduce the risk of puncture-related complications.

Stop posterior wall puncture of the arteriovenous graft (AVG). New findings of cannulation techniques from a prospective observational study with an AVG model and plastic cannula for dialysis.

Posterior wall puncture of the AVG causes serious vascular access complications, but there is no concrete technical recommendation for AVG cannulation with plastic cannula. The purpose of this study is to identify cannulation techniques to reduce posterior wall puncture of the AVG using plastic cannula. Sixty-three hemodialysis nurses' cannulations on experimental models were recorded and included in this study. Cannulations were conducted on AVG and AVF models with a plastic cannulation needle. We analyzed the angle of the needle, the motion of the needle, and the location of the needle in the graft lumen. The occurrence of posterior wall puncture of the AVG model was 22.2%. The cannulation angles in the AVG model were greater than those in the AVF model (p < 0.05). In the posterior wall puncture group of the AVG model, after the tip of the needle had reached into the graft lumen, the angle of the needle was not flattened (p < 0.05) and the outer sleeve of the needle was not inserted into the graft (p < 0.05). Furthermore, posterior wall puncture of the AVG model were observed in the group with less than 5 years of dialysis nursing experience (p < 0.05). From this study, after the tip of the needle had reached into the graft lumen, flattening the angle of the needle and inserting the outer sleeve of the needle into the graft were suggested as specific cannulation techniques to reduce posterior wall puncture of the AVG. Furthermore, this study also suggests the importance of cannulation technique education for new dialysis nurses to reduce cannulation-caused complications.

Distal radial artery as an alternative approach to forearm radial artery for perioperative blood pressure monitoring: a randomized, controlled, noninferiority trial

BackgroundThe novel distal radial artery (dRA) approach is a popular arterial access route for interventional cardiology and neurointerventions. We explored the dRA as an alternative site to the classic forearm radial artery (RA) for perioperative blood pressure monitoring. We hypothesized that dRA catheterization is noninferior to RA for the first attempt success rate.MethodsThis was a single-center, prospective, randomized controlled, noninferiority study. Adult patients who underwent elective surgery at the Jinling Hospital from May 2021 to August 2021 were enrolled. The primary endpoint was to test the noninferiority of the first attempt success rate between the groups. Secondary endpoints included anatomical characteristics, catheterization time, arterial posterior wall puncture rate, postoperative compression time, dampened arterial pressure waveforms, and complications.ResultsTotally, 161 patients who received either dRA (n = 81) or RA (n = 80) catheterization were analyzed. The first attempt success rates were 87.7 and 91.3% in the dRA and RA groups, respectively, with a mean difference of − 3.6% (95% CI, − 13.1 to 5.9%). The dRA diameter and cross-sectional area were significantly smaller than those of the RA (P < 0.001). The subcutaneous depth of dRA was significantly greater than that of the RA (P < 0.001). The dRA had a longer catheterization time (P = 0.008) but a shorter postoperative compression time (P < 0.001). The arterial posterior wall puncture rate of dRA was significantly higher than that of the RA (P = 0.006). The dRA had fewer dampened arterial waveforms than RA (P = 0.030) perioperatively.ConclusionsThe dRA is a rational alternative approach to RA for perioperative arterial pressure monitoring and provides a noninferior first attempt success rate.Trial registrationThis study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2100043714, registration date: 27/02/2021).

Modified long-axis in-plane ultrasound-guided radial artery cannulation in adult patients: A randomized controlled trial

IntroductionFor adults with small radial arteries, ultrasound-guided radial artery cannulation remains challenging and the relevant data is currently lacking. The study aimed to test the hypothesis that modified long-axis in-plane ultrasound guidance (M-LAIP) would improve success rates of radial artery cannulation in this population. Patients and methodsThis was a prospective, randomised, and controlled clinical study that enrolled 201 adult patients with diameters of the radial artery less than 2.2 mm. Patients were randomised to M-LAIP, short-axis out-of-plane (SAOP), or conventional palpation (C-P) group according to different approaches of radial artery cannulation (M-LAIP, SAOP, and C-P). Outcome measurements included the success rate, cannulation time, and cannulation-related adverse events. ResultsThe cannulation success rate was significantly higher in the M-LAIP group than in the SAOP or C-P groups (first success rate: 80.3% vs. 53.8% or 33.8%; P < 0.001; total success rate: 93.9% vs. 78.5% or 50.8%; P < 0.001). Total cannulation time in the M-LAIP group was shorter than that in the SAOP group (P = 0.002) or the C-P group (P < 0.001). The rates of posterior wall puncture and haematoma in the M-LAIP group were lower than that in the SAOP group or C-P group (P < 0.008). ConclusionThe use of the M-LAIP approach significantly improved the success rate of radial artery cannulation, shortened procedure time, and lowered the rates of posterior wall puncture and haematoma in adults with radial artery diameters less than 2.2 mm, compared with that achieved by the SAOP or C-P approach.

A Comparison between Ultrasound-guided Short-axis Approach and Oblique Axis Approach for Internal Jugular Venous Cannulation in the Emergency Department.

Background:Central venous catheter (CVC) placement is a frequently performed procedure in the emergency department (ED). We aim to compare two different ultrasound (US)-guided techniques, the short-axis (SAX) approach and the oblique axis (OAX) approach for the insertion of internal jugular vein (IJV) catheters in an ED setting.Methods:This prospective, observational study was conducted in the ED of a single tertiary care teaching hospital on patients requiring IJV cannulation. CVC placement was done using both the SAX and OAX approaches as per the ED physician's discretion. Outcome measures included acute complications, successful insertion of an IJV catheter, number of attempts, and access times. The Chi-square test was used to compare the study variables (acute complications, number of cannulation attempts, and successful cannulation) between the two approaches. Mann–Whitney U-test was applied to compare the mean differences of flash time and cannulation time.Results:Sixty patients were enrolled, of which 30 underwent IJV cannulation by the SAX technique and 30 by the OAX technique. We noted a total of 22 acute complications, 56.7% in the SAX group and 16.7% in the OAX group. A significant incidence of posterior venous wall puncture was noted in the SAX group (50.0%). No significant statistical differences were noted on analysis of other outcome measures.Conclusion:The OAX approach is a useful alternative technique to IJV cannulation in the ED setting. Further multicentric studies in this domain will be required to consider this technique as the primary approach to US-guided IJV cannulation in the ED setting.

ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients.

ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients.

Incidence of posterior vessel wall puncture during ultrasound guided vascular access: Short axis versus long axis approach.

Background and Aims:Posterior vessel wall puncture (PVWP) is a common complication of ultrasound (US) guided central venous cannulation. We evaluated and compared the frequency of PWVP of internal jugular vein using short axis (SA) and long axis (LA) approach of US-guided needle cannulation. As a secondary objective incidence of carotid puncture was assessed.Material and Methods:Prospective, single-blinded, cross over, observational study at Urban Level I Neuroanesthesiology and Critical Care Department. Residents receiving standard education on ultrasound-guided central venous cannulation were asked to place an US-guided catheter using either short axis or long axis approach on a human torso mannequin. During the procedure, the path of the needle was carefully observed by the investigator for any PVWP and carotid puncture without interference with the placement procedure. The confidence level of the resident for the intraluminal placement of the needle tip was measured on a 10-point Likert scale.Results:Forty residents participated in the study. The incidence of PVWP in SA and LA group was 40% and 17.5% respectively and was statistically significant (p = 0.026). There was no incidence of carotid artery puncture in either of the group. The mean confidence of intraluminal placement of needle was significantly higher in the LA group (8.32) as compared to the SA group (5.95).Conclusion:Lower incidence of PVWP was seen in LA as compared to the SA approach during US-guided IJV cannulation in phantom in residents having previous experience of CVC (central venous cannulation) in landmark technique only. Participants were more confident about intraluminal needle placement in the LA group compared to the SA group.

Comparison of three different techniques for internal jugular vein cannulation under real time ultrasound guidance

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ultrasound (USG) guided Internal jugular venous (IJV) cannulation is preferred than traditional approach due to increase in success rate, reduction in time taken and attempts of successful cannulation and less complications. The purpose of our study was to observe and compare three different real time 2-dimensional US-guided approaches and to determine which approach improves rate of successful cannulation, decreases complications along with shorter average time taken for the procedure. Primary outcomes of the study were venous access time, catheterization time and success rate. Secondary outcomes were number of patients requiring second attempt and complications observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;120 adult patients were randomly divided into three groups according to real time US guided cannulation done with SAX-OP approach, LAX-IP approach and OAX-IP approach. Parameters like venous access time, catheterization time, number of patients requiring second attempt and complications were noted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Venous access time was shortest in LAX group 21.84±3.67 seconds which was just significant statistically. Catheterization time was shortest in LAX group 241±123 seconds. Cannulation success rate was highest in LAX group 98% and was statistically significant. Patients requiring second attempt was least in LAX group 2.5%. Posterior IJV wall puncture was observed in 10% patients in SAX group and none in LAX and OAX group which was statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; LAX-IP showed better performance in terms of higher cannulation success, lesser average venous access time and catheterization time and lesser complications. On toggling USG probe, both IJV and carotid artery can be differentiated and carotid puncture could be avoided. Hence LAX approach is safer and effective approach.&lt;/p&gt;

Prevention of posterior wall puncture with a self-made needle block.

Vascular access is one of the most commonly performed invasive procedures in medicine. Ultrasound-guided vascular access has been shown to improve patient safety, decrease associated complications and increase first attempt success rates, however, the risk for a posterior venous wall puncture (PVWP) still exists. To reduce this complication, needle guides have been used, though, current methods have limited accessibility and generalizability. Thus, the aim of this article is to describe how a self-made needle block constructed with materials present in a central line kit can reduce the incidence of PVWP and its associated complications in novice POCUS users.

Comparison of Three Ultrasound Views for Internal Jugular Venous Cannulation in Patients Undergoing Cardiac Surgery: A Randomized Trial.

Background:The quality of needle visualization during ultrasound-guided internal jugular vein (IJV) cannulation determines the ease of procedure, whereas posterior IJV wall puncture is the most common risk associated. The IJV can be imaged in different views, which offer certain advantages over each other. We compared three different ultrasound views for IJV cannulation short axis (SAX), long axis (LAX), and oblique axis (OAX) with respect to the quality of needle visualization, first pass success rate, and posterior IJV wall puncture.Methods:Two hundred ten patients undergoing elective cardiac surgery were analyzed in this prospective randomized clinical trial. Patients were randomly assigned to one of the three groups: SAX (n = 70), LAX (n = 70), and OAX (n = 70). The quality of needle visualization, first pass success rate, and incidence of posterior IJV wall puncture in each of the three ultrasound views were studied. The Chi-square test and ANOVA were used for the comparison of means and proportion between the groups.Results:The quality of needle visualization was graded as good in 90% patients in OAX group, 81.4% patients in LAX group, and 14.2% patients in SAX group, respectively (P < 0.0001). OAX group had the highest first pass success rate (94.2%) followed by SAX (88.5%), and then, LAX (82.8%), but it was statistically insignificant among the groups (P = 0.105). The mean IJV access time was longer in LAX group when compared to OAX and SAX group (P < 0.0001).The incidence of IJV posterior wall puncture was 14.2% patients in SAX group and none in other groups (P = 0.0011).Conclusion:The results suggest that OAX view can be adopted as standard approach during ultrasound-guided IJV cannulation as it safe and reliable.