[Ultrasonography guided versus anatomically oriented puncture of the internal jugular vein for central venous...

Ultrasonography guided puncture (UGP) of the internal jugular vein (IJV) carried out by an expert is considered to be superior to the anatomically orientated puncture (AOP). Whether routine use of the UGP lowered the number of unsuccessful punctures and complications was unknown. Both puncture techniques were compared in a random study.

Between 10/93 and 3/94, 77 patients who needed central venous catheterisation for thorax or cardiac surgery were included in the study. 84 (42 vs 42) punctures were performed by seven anesthetists, all of whom had a great deal of experience with AOP, using either one or the other technique. The UGP was demonstrated and assisted once by an expert. A conventional ultrasound unit with a 7.5 MHz transducer was used. The number of unsuccessful first punctures, overall rate of unsuccessful punctures, morbidity and puncture time were compared.

The unsuccessful first punctures using UGP occurred significantly less frequently (7 vs 19, p < 0.005). Fewer unsuccessful punctures were evidenced (9 vs 73, p < 0.001). One arterial puncture occurred with each of the puncture techniques. Five hematomas were observed in patients where AOP was used. Four of these patients were adipous and at least six unsuccessful punctures had already been carried out. The punctures lasted comparatively the same length of time (UGP: 59 s vs AOP: 60 s, p > 0.05).

UGP is superior to AOP of the IJV also in routine use. It should be used more frequently in elective situations.