Ultrasound guided venous cannulation facilitates the learning ability of the internal jugular vein catheterization technique

Eugen Tincu
Secţia ATI, Spitalul Municipal de Urgenţă Moineşti

Abstract

Introduction. Internal jugular vein cannulation is usually performed by a “blind” procedure, using the “landmark” technique. In patients with local or systemic risk factors the placement of the central venous catheter by this technique may be accompanied by complications. Real time ultrasound guided cannulation represents a fast and safe alternative.

Goals. The evaluation of the performance ease (number of attempts and duration of insertion) and of the safety (complication incidence) of the two methods when they are performed by an unexperienced anaesthetist competent in ultrasonography.

Material and method. 68 patients with risk factors for central vein cannulation were divided in two groups: one group – 34 patients were cannulated by the “landmark” technique and the second group – 34 patients were cannulated by the real time ultrasound guided technique with a 7.5 MHz linear probe for intraoperative use with guidance system for needle insertion.

Results. Central venous cannulation was successful in all cases within both groups. The average number of attempts for vein identification was 2 in first group (88.23% of patients) and one in the second group (100% of patients) (p = 0.001). The average duration of cannulation was 5.25 ± 2.00 minutes in the first group and 1.49 ± 0.27 minutes in the second group (p<0.001). Accidental puncture of the carotid artery was recorded in 2 cases and cardiac arhythmias in 7 cases in the first group, and only one complication in the second group (p < 0.05).

Conclusions. Real time ultrasound guided venous cannulation facilitates the learning ability of the internal jugular vein catheterization technique by an unexperienced anaesthetist, who has knowledge/skills in ultrasonography. The internal jugular vein cannulation by this method is safer than the conventional “blind” procedure, of choice for the ICU patient who has an increased risk of complications.

Key words: internal jugular vein, ultrasound guided cannulation, learning ability