A randomized study of left versus right internal jugular vein cannulation in adults

Study Objective: To compare the success rate and: incidence of complication s of right internal jugular vein (RIJV) versus left internal jugular vein ( LIJV) cannulation using external landmarks or surface ultrasound guidance. Design: Prospective randomized study. Setting: Operating room of a university-affiliated hospital. Patients: 120 adult patients scheduled for elective abdominal, vascular, or cardiothoracic procedures with general anesthesia and mechanical ventilati on in whom central venous cannulation was clinically indicated. Interventions: Patients were randomized to four groups for RIJV cannulation using the landmark approach (Group 1) or surface ultrasound (Group 2) vers us LIJV cannulation with the landmark approach (Group 3) or ultrasound (Gro up 4). Measurements and Main Results: The data collected included time from first puncture to guidewire insertion, number of attempts, and associated complic ations. If conversion to the ultrasound technique was required the number o f crossover patients and reasons for failure were recorded. Cannulation of the LIJV was more time consuming it required more attempts; and it was asso ciated with a greater. number of complications when compared to the right s ide (p < 0.05). Conclusions: Left IJV cannulation is more limg consuming than RIJV cannulat ion and is associated with a higher incidence of complications. The use of ultrasound improves success rate and decreases the number of complications during IJV cannulation. (C) 2000 by Elsevier Science Inc.