ULTRASOUND MONITORING IN CANNULATION OF THE INTERNAL JUGULAR-VEIN - ANATOMIC AND TECHNICAL CONSIDERATIONS

OBJECTIVE: To examine the effect of variations in anatomic features an d operator experience on the success and complication rates of sonogra phically monitored cannulation of the internal jugular vein. PATIENTS AND METHODS: The authors prospectively collected data for ultrasound-m onitored cannulation of the internal jugular vein in 150 patients. In all cases the radiologist recorded the side of puncture, the number of passes needed, the number of vein punctures (one or two), whether the walls were opposed during puncture and any complications. For the las t 80 patients the following information was also recorded: the distanc e from the skin to the internal jugular vein, the diameter of the vein with the Valsalva manoeuvre and the location of the vein relative to the carotid artery. All but three of the cannulations were performed b y one of three radiologists, all of whom had at least 5 years of exper ience. RESULTS: Cannulation was successful in all of the patients, and the first pass was successful in 133 (88.7%). These results are bette r than those of blind placement techniques reported in the literature. The only complications were hematoma and carotid puncture, which both occurred in the same two patients (1.3%). There was no significant di fference among the radiologists in the number of passes needed (one-wa y analysis of variance, p > 0.05). The number of passes was independen t of anatomic factors, including depth from skin, vein diameter or rel ative location. However, significantly more passes were needed for lef t-side punctures than for right-side punctures (Student t-test, p < 0. 05). CONCLUSIONS: Real-time ultrasound monitoring is superior to blind techniques in cannulation of the internal jugular vein because of its ease, accuracy and safety. Sonographic real-time monitoring minimizes the impact of anatomic factors on success and complication rates. It is a safe and efficacious approach that should be preferred in the pla cement of central lines.