Internal Jugular Vein is routinely cannulated for long term infusion of drugs irritating the peripheral veins, vasopressor therapy, total parenteral nutrition, chemotherapy agents, antibiotics, repeated blood sampling, trans venous cardiac pacing and haemodialysis in critical care patients. The safe puncture of internal jugular vein can be achieved by using anatomical landmarks in the neck region. However, complications like carotid artery puncture, haematoma, haemothorax, pneumothorax, catheter malposition or even death can occur as consequences of the procedure. Ultrasound guidance could be beneficial in reducing the number of needle passes and decreasing the complications. The present study observed the cannulation techniques of internal jugular vein by anatomical landmark guided and real-time ultrasound guided approach and compared whether the use of ultrasound improves the safety of the technique. In this study, hundred patients requiring right internal jugular vein cannulation via central approach were allocated to one of the two groups- anatomical landmark guided or real-time ultrasound guided group (50 in each group) based on the technique of cannulation. In our study, there was 86% success rate for first attempt cannulation in the ultrasound guided technique and 68% in the anatomical landmark guided technique. The complication rates were 7 (14 %) in ultrasound guided group vs. 19 (38%) in the landmark guided group. Ultrasound guided technique improves the catheterization technique of the internal jugular vein with respect to safety of the procedure.

Keywords: Central venous cannulation, Internal Jugular Vein, Anatomical Landmark, Real-time ultrasound.

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Geetha N.K.

Additional Professor, Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala

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