Comparison of Three Techniques for Ultrasound Guided Internal Jugular Vein Cannulation

Author(s): Divya Sujatha Sivadasan1 , Arun Gopinathan Kurup2 , Aswathy Sarath3

BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Central venous catheterization is now an unavoidable component for invasive monitoring and management. Central venous access was first given by Aubaniac1 in 1953. Cannulation of the internal jugular vein is a procedure commonly performed by anaesthetists, in both the perioperative period and in intensive care.2 The internal jugular route for central venous access has been described as early as in 1966 by Hermosura.3 The very first and one of the most commonly followed method for central venous catheterization remains a blind surface landmarkguided technique. Ultrasonography guidance in central venous cannulation has converted a blind procedure into a procedure under vision which helps in reducing the complication rates. The aim of the study is to compare three ultrasound guided techniques (short axis vs long axis vs oblique axis) for cannulation of the right internal jugular vein. METHODS This is an observational study conducted among 151 patients who fulfilled the inclusion criteria and who had given a written informed consent. The patients were divided into groups of 51 each. Group 1- Short axis approach (SAX), Group 2- Long axis approach (LAX), Group 3- Oblique axis approach (OAX). The outcome variables used were- 1. Successful cannulation with the designated approach, 2. First needle pass success n (%), 3. Number of needle passes, 4. Cannulation time (s). 5. Complications. RESULTS The findings of the study indicate that Oblique axis approach to IJV cannulation is better than Long or Short axis approach in terms of number of needle passes, first needle pass success, and cannulation time . There was no statistically significant difference in complication rates among the three groups. CONCLUSIONS It can be concluded that while performing ultrasound guided Internal Jugular Vein cannulation, the Oblique axis approach can be considered as a safe and effective approach.