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Comparative Effectiveness of Ultrasound-Guided Posterior Approach versus Landmark-Based Middle Approach for Internal
Ling'an Yu1, Ziqi Feng1, Yingmin Han1
1Department of Nephrology, Taizhou First People's Hospital, Taizhou, People's Republic of China.
Objective:
To evaluate the teaching effectiveness of bedside ultrasound-guided posterior internal jugular vein puncture in the training of resident physicians.
Methods:
From March 2019 to June 2024, 24 resident physicians at Taizhou First People's Hospital were randomly assigned to a study group (n=12) and a control group (n=12). The study group received simulation-based training using a Mindray ultrasound skill training system, including repeated practice on a phantom model, followed by supervised patient procedures. The control group received training in anatomical landmark-based middle internal jugular vein puncture with equal practice time. Both groups received 2 hours of didactic teaching and self-study materials. Each physician performed the procedure on three patients, resulting in 36 cases per group. Procedural success was defined as successful guidewire insertion and catheter placement, confirmed by blood aspiration and subsequent chest X-ray. After completing the procedures, resident satisfaction was assessed using a standardized questionnaire.
Results:
The study group had a 100% success rate, compared to 66.67% in the control group (χ2=14.40, P<0.001). First-attempt success rates were 83.33% in the study group versus 41.76% in the control group (χ2=13.33, P<0.001). The study group required fewer attempts (1.22±0.54 versus 1.92±0.91, t=-3.95, P<0.001), had no arterial punctures (0% versus 19.44%, χ2=5.70, P=0.02), and shorter procedure times (4.53±3.09 versus 7.08±4.99 minutes, t=-2.61, P=0.01). Resident satisfaction was higher in the study group (100% versus 58.33%, χ2=4.04, P=0.01), No pneumothorax, hemothorax, or clinically significant hematoma occurred in either group. Post-procedural chest X-ray confirmed correct catheter tip position in all 72 patients (100%).
Conclusion:
Short-term training in bedside ultrasound-guided posterior internal jugular vein puncture enables resident physicians to master this technique effectively, demonstrating good clinical application outcomes.
