Ultrasound Versus the Landmark Technique: A Prospective Randomized Comparative Study of Internal Jugular Vein Cannulation in an Intensive Care Unit

  • B R Shrestha Department of Anesthesiology and ICU, Kathmandu Medical College-Teaching Hospital, Kathmandu
  • B Gautam Department of Anesthesiology and ICU, Kathmandu Medical College-Teaching Hospital, Kathmandu

Abstract

OBJECTIVE:

The aim of this study is to find out if an ultrasound technique has advantages over the conventional landmark technique.

METHODS:

This is a prospective randomized comparative study on 120 patients requiring central venous cannulation of the right internal jugular vein. The study comprised of two groups: ultrasound and landmark groups, each consisting of 60 patients. The outcome measures were compared between the groups.

RESULTS:

Cannulation of the internal jugular vein was successful in 58 patients in the ultrasound group and in 53 in the landmark group. The number of attempts was 1.5 (1 - 3) and 2 (1 - 3) in the ultrasound and landmark group respectively (p = 0.001). The time taken for the successful cannulation was 4.9 +/- 1.7 minutes in the ultrasound approach and 8.0 +/- 2.8 minutes in the landmark approach (p = 0.00). The internal jugular vein diameter in the supine position was 11.2 +/- 1.5 mm which increased to 15.04 +/- 1.5 mm with a 15 degrees head-down position in the USG group (p = 0.001). The first attempt success rate was 39/60 (63%) in the ultrasound group and 19/60 (32%) with the landmark technique. The seven (12%) failure cases in the landmark group were rescued by the ultrasound technique. Inadvertent carotid artery puncture occurred in 2/60 (3%) and 6/60 (10%) of patients in the ultrasound and land mark group respectively.

CONCLUSIONS:

Ultrasound improves success rate, minimizes cannulation time and complications during internal jugular vein cannulation. It can be employed as a rescue technique in cases of a failed landmark technique.

Keywords:cannulation, central, landmark, technique, ultrasound.

Published
2011-06-30
How to Cite
Shrestha, B. R., & Gautam, B. (2011). Ultrasound Versus the Landmark Technique: A Prospective Randomized Comparative Study of Internal Jugular Vein Cannulation in an Intensive Care Unit. Journal of Nepal Medical Association, 51(182). https://doi.org/10.31729/jnma.148
Section
Original Article