Abstract:
Background and objective: Historically, landmark techniques for central venous access through the internal jugular vein (IJV) have yielded a lesser success rate and higher complication rate than the ultrasound (US) guided approach. The purpose of this study to assess the success and safety of a novel external jugular vein (EJV) based LM (EJV-LM) approach compared to the real-time US-guided approach for central venous access through the internal jugular vein.
Methods: This was a prospective, randomized, cross over trial performed in patients during elective cardiac and non-cardiac surgery. Each resident randomly inserted a central venous catheter using EJV-LM approach and real-time US-guided approach. The primary outcome was first attempt success. Secondary outcomes included overall success rate, number of puncture attempts, cannulation time, hematoma and mechanical complications.
Results: A total of 188 patients were randomly assigned to the EJV-LM and US groups. The demographic characteristics of the groups were comparable. The first attempt success was not different between EJV-LM and US-guided technique {79.8%; (95% CI: 70.2-87.4) vs 89.4% (95% CI 81.3-94.8); p=0.06}. The overall success rate was 100% with both techniques. There were no differences in the number of puncture attempts with introduce needle {1(1-3) vs 1(1-2); p=0.07). Cannulation time was longer in the EJV-LM group compared to the US group (58.11±6.6 vs. 44.27±5.28 seconds; P=0.0001). EJV-LM technique was associated to a higher occurrence of overall complications compared to the US technique {12.8% (95% CI :6.7- 21.2) vs 4.2% (95% CI:1.1-10.5); P=0.03}. No major mechanical complications were observed with either technique.
Conclusions: In patients with non-distorted neck anatomy and a visible EJV, IJV catheterization using the EJV-based LM approach and standard US-guided technique yielded similar first attempt and overall success rates. Cannulation time was longer and complications occurred more frequently in the EJV-based LM compared to the standard US-guided technique.
Reference:
Vinayagamurugan A, Badhe AS, Jha AK. Comparison of External Jugular Vein based surface landmark approach and Ultrasound guided approach for Internal Jugular Venous cannulation: A randomized cross over clinical trial. Int J Clin Pract. 2020 Oct 23:e13783. doi: 10.1111/ijcp.13783. Epub ahead of print. PMID: 33095965.