Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial

• Published in: Chest Vol. 98; no. 1; p. 157
• Main Authors: Mallory, D L, McGee, W T, Shawker, T H, Brenner, M, Bailey, K R, Evans, R G, Parker, M M, Farmer, J C, Parillo, J E
• Format: Journal Article
• Language: English
• Published: United States 01.07.1990
• Subjects: Catheterization, Central Venous - methods; Humans; Jugular Veins - anatomy & histology; Prospective Studies; Randomized Controlled Trials as Topic; Ultrasonography - methods
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.98.1.157

To compare conventional versus ultrasound-guided internal jugular vein cannulation techniques. 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. Clinical research unit in a tertiary care center. All consecutive patients who required urgent or urgent-elective internal jugular vein cannulation during the study period. 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. 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). 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.