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Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial
D L Mallory1, W T McGee, T H Shawker
1Department of Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda, MD.
Study Objective:
To compare conventional versus ultrasound-guided internal jugular vein cannulation techniques.
Design:
Patients were randomly assigned to receive either conventional or two-dimensional ultrasound-guided internal jugular vein cannulation. Patients who could not be cannulated with five or fewer passes by either technique, were crossed over to the other technique.
Setting:
Clinical research unit in a tertiary care center.
Patients:
All consecutive patients who required urgent or urgent-elective internal jugular vein cannulation during the study period.
Interventions:
The two-dimensional ultrasound transducer imaged all cannulation attempts. For patients randomized to ultrasound guidance, the operator viewed two-dimensional ultrasound images, and received verbal guidance from the ultrasound technician. For patients randomized to the conventional arm, two-dimensional ultrasound images were recorded without visual or verbal feedback.
Measurements And Main Results:
Two-dimensional ultrasound was significantly better than conventional guidance in reducing the number of failed site cannulations from 6/17 (35 percent), to 0/12 (0 percent), p less than 0.05. Two-dimensional ultrasound also reduced the mean number of passes required to cannulate the vein from 3.12 to 1.75 (p less than .05), and was also successful in six/six (100) of patients who failed cannulation by conventional means (p less than 0.05).
Conclusions:
Intensivists can increase successful internal jugular vein cannulation using ultrasound guidance. Two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.