IMPROVEMENT OF INTERNAL JUGULAR-VEIN CANNULATION USING AN ULTRASOUND-GUIDED TECHNIQUE

Objective:To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU, Design: Pros pective, randomized study. Setting: General Intensive Care Unit of a U niversity Hospital. Patients: Seven-nine patients were assigned to int ernal jugular vein cannulation using anatomical landmarks alone (contr ol group, n = 42) or with ultrasound guidance (ultrasound group, n = 3 7), Intervention: All cannulations were performed by junior house staf f under the direct supervision of a senior physician. In the ultrasoun d group, an ultrasonography (7.5 MHz) was used and the transducer was covered by a sterile sheath, The placement and direction of the cannul ating needle were determined on the ultrasound image, Measurements and results: Internal jugular vein cannulation was successful in 37/37 (1 00 %) patients in the ultrasound group and in 32/32 patients (76 %) in the control group (p < 0.01), Average access time was longer in the c ontrol group (235 +/- 408 s vs 95 +/- 174 s, p = 0.06) and carotid art ery puncture occurred in five patients in each group (p = 0.83). Jugul ar cannulation was successful at the first attempt in 26 % in the cont rol group and 43 % in the ultrasound group (p = 0.11). Thirty-two pati ents (86 %) in the ultrasound group and 23 patients (55 %) in the cont rol group (p < 0.05) were cannulated within 3 min. The cannula could t herefore not be inserted within 3 min in 19 patients (45 %) in the con trol group, Failure was explained by thrombosis (n = 1), small caliber of the internal jugular vein (< 5 mm, n = 3), abnormal vascular relat ions (n = 3), Among the ten primary failures of cannulation, an intern al jugular vein catheter was able to be inserted in four cases by an e xperienced physician on the side initially selected and with ultrasoun d guidance in two cases. The catheter was inserted into the contralate ral internal jugular vein under ultrasound guidance in the remaining f our cases. Conclusion: Ultrasound guidance improved the success rate o f jugular vein cannulation in ICU patients. Our results suggest that u ltrasound guidance should be used when the internal jugular vein has n ot been successfully cannulated within 3 min by the external landmark- guided technique.