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

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

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OBJECTIVE: The aim of this study here 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 click here 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.