Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients

OBJECTIVE: To investigate whether prepuncture ultrasound evaluation of vascular anatomy facilitates internal jugular vein cannulation compared with landmark-guided puncture.

DESIGN: Prospective randomized study.

SETTING: Single community hospital.

PARTICIPANTS: Adult patients undergoing general anesthesia (n = 240).

INTERVENTIONS: The right internal jugular vein was cannulated using either anatomic landmarks or prepuncture ultrasound (3.75/7.5 MHz) guidance. In the landmark group, respiratory jugular venodilation was used as the primary landmark for locating the vein. Results of cannulation and the incidence of complications were compared.

MEASUREMENTS AND MAIN RESULTS: Patients were randomly assigned to the ultrasound or landmark group. Respiratory jugular venodilation was identified in 188 patients (78.3%), in whom results of cannulation did not differ between the 2 techniques with respect to the venous access rate (cannulated at the first attempt: 83.5% in the landmark v 85.7% in the ultrasound group), the success rate (cannulated within 3 attempts: 96.9% v 95.6%), and the incidence of arterial puncture (1.0% v 3.3%). In the remaining 52 respiratory jugular venodilation-unidentified patients, the access rate (30.4% v 86.2%, p < 0.001) and the success rate (78.3 v 100%, p < 0.05) were significantly better in the ultrasound group, and no arterial puncture was recorded in the ultrasound group, whereas the incidence was 13.0% in the landmark group. The results were similar regardless of the ultrasound frequency used.

CONCLUSION: Prepuncture ultrasound evaluation did not improve the result of right internal jugular vein cannulation compared with the respiratory jugular venodilation-guided approach. When the landmark was not observed, however, the prepuncture ultrasound guidance was helpful in facilitating the cannulation.