ULTRASOUND-ASSISTED CANNULATION OF THE INTERNAL JUGULAR-VEIN - A PROSPECTIVE COMPARISON TO THE EXTERNAL LANDMARK-GUIDED TECHNIQUE

Background. Central venous access is an essential part of patient mana gement in many clinical settings and is usually achieved with a blinde d, external landmark-guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve on the tradition al method. Methods and Results. We prospectively evaluated an ultrasou nd-guided method in 302 patients undergoing internal jugular venous ca nnulation and compared the results with 302 patients in whom an extern al landmark-guided technique was used. Ultrasound was used exclusively in an additional 626 patients. Cannulation of the internal jugular ve in was achieved in all patients (100%) using ultrasound and in 266 pat ients (88.1%) using the landmark-guided technique (p<0.001). The vein was entered on the first attempt in 78% of patients using ultrasound a nd in 38% using the landmark technique (p<0.001). Average access time (skin to vein) was 9.8 seconds (2-68 seconds) by the ultrasound approa ch and 44.5 seconds (2-1,000 seconds) by the landmark approach (p<0.00 1). Using ultrasound, puncture of the carotid artery occurred in 1.7% of patients, brachial plexus irritation in 0.4%, and hematoma in 0.2%. In the external landmark group, puncture of the carotid artery occurr ed in 8.3% of patients (p<0.001), brachial plexus irritation in 1.7% ( p<0.001), and hematoma in 3.3% (p<0.001). Conclusions. Ultrasound-guid ed cannulation of the internal jugular vein significantly improves suc cess rate, decreases access time, and reduces complication rate. These results suggest that this technique may be preferred in complicated c ases or when access problems are anticipated.