Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique.

OBJECTIVE To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. STUDY DESIGN Randomized controlled trial. PLACE AND DURATION OF STUDY Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. METHODOLOGY A total of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. RESULTS Access time was significantly less in real-time ultrasound group (34.95 ± 11.47 vs. 146.59 ± 40.20 seconds, p < 0.001). Cannulation was performed in first attempt in 99% of patients in ultrasound group as compared to 89% of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate (9% vs. 1%) and haematoma formation (7% vs. 0%) were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group (6% vs. 0%). CONCLUSION Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein.