A comparison of two techniques of internal jugular vein cannulation: Landmark-guided technique versus ultrasound-guided technique

Background: This study was designed to compare the overall success rates and complications of two techniques of internal jugular vein (IJV) catheterization, namely the landmark (LM)-based technique and ultrasound (US)-guided technique in a heterogeneous Indian population at an Armed Forces Tertiary Care Hospital. Methods: Ninety consenting patients were assigned to two groups: LM and US groups. Patients with known coagulation abnormalities, body mass index > 30, infection at the insertion site, known vascular abnormalities, burn contractures, and other dermatologic conditions that precluded an LM technique were excluded. Central venous catheterizations during the code blue scenarios were excluded due to the emergent nature of the procedure. Three operators from the author group with requisite experience in LM and US techniques performed the 90 catheterizations. In LM group, a finder needle with a 2 ml syringe was used to aspirate venous blood from the IJV. A 16G needle was guided in the same direction as the finder needle till venous blood was aspirated, followed by guidewire insertion and cannulation. In the US group, a 6-12 MHz linear US probe was used to identify the IJV in real time and a 16G needle was used to access the IJV under US guidance in the cross-sectional view. Results: The overall success rate was 84.4% in LM group and 100% in US group (P = 0.0059). The first attempt success rate was similar in both groups (71.1% and 86.6%, P = 0.07). The overall complication rates in LM group were 20%, whereas complications in the US group were 2.2% (P = 0.0073). Notably, vascular complications occurred less frequently in US group with fewer arterial punctures and hematomas. Hemothorax and pneumothorax did not occur in any group. The mean cannulation time decreased by 69 s, i.e., from 276 s in the LM group to 207 s in the US group (P < 0.001). Conclusion: US-guided central venous catheter insertion to IJV improves the overall success rate and reduces cannulation time as compared to conventional LM-based technique.