KUMJ | VOL. 23 | NO. 4 | ISSUE 92 | OCTOBER-DECEMBER
Ultrasound-guided in-plane and Out-of-plane Techniques Versus Landmark Technique for Internal Jugular Vein Catheterization in Adult Cardiac Surgery Patients
Amatya A, Pudasaini A, Bhusal S, Bajracharya SM, Shrestha BK, Pandey P, Shrestha BM
Abstract: Background
Internal jugular vein (IJV) catheterization is routinely performed in cardiac surgical
patients. Ultrasound (US) guidance has been shown to increase success rates and
reduce complications compared to landmark (LM) techniques; however, access to
ultrasound machines and operator skill remain limitations in several centers.
Objective
To compare two different real-time 2-dimensional ultrasound-guided short axis/outoff-
plane (SAX OOP) and long axis/in-plane (LAX IP) approaches and to determine
whether ultrasound guidance could improve the success rate and decrease the
complication rate of internal jugular vein catheterization compared with the
landmark approach (LM).
Method
This Prospective, randomized comparative study evaluated three techniques for
internal jugular vein cannulation in adult elective cardiac surgery patients (n=90):
(1) real-time short-axis/out-of-plane ultrasound guidance (SAX-OOP), (2) realtime
long-axis/in-plane ultrasound guidance (LAX-IP), and (3) landmark technique
(LM). Primary outcomes included number of attempts and procedure duration.
Secondary outcomes included mechanical complications. Chi-square for categorical
variables and one-way ANOVA for continuous variables were applied to find out the
associations.
Result
First-attempt success was highest in LAX-IP (100%), followed by SAX-OOP (96.7%) and
LM (83.3%) (p=0.024). All complications (n=7) occurred in the LM group (p=0.001).
Mean cannulation time was significantly longer in the LM group (90.83±13.23
seconds) versus SAX-OOP (60.47±10.96 seconds) and LAX-IP (70.47±23.10 seconds)
(p<0.001).
Conclusion
Real-time ultrasound guidance, particularly the in-plane technique, significantly
improves success rates, reduces complications, and shortens cannulation time
compared with the landmark technique. Ultrasound guidance should be preferred
for internal jugular vein cannulation in cardiac anesthesia settings.
Keyword : Central venous catheterization, Internal jugular vein, Ultrasound guidance, Landmark technique, Cardiac anesthesia
