Ultrasound monitoring in cannulation of the internal jugular vein: anatomic and technical considerations.
OBJECTIVE
To examine the effect of variations in anatomic features and operator experience on the success and complication rates of sonographically monitored cannulation of the internal jugular vein.


METHODS
The authors prospectively collected data for ultrasound-monitored cannulation of the internal jugular vein in 150 patients. In all cases the radiologist recorded the side of puncture, the number of passes needed, the number of vein punctures (one or two), whether the walls were opposed during puncture and any complications. For the last 80 patients the following information was also recorded: the distance from the skin to the internal jugular vein, the diameter of the vein with the Valsalva manoeuvre and the location of the vein relative to the carotid artery. All but three of the cannulations were performed by one of three radiologists, all of whom had at least 5 years of experience.


RESULTS
Cannulation was successful in all of the patients, and the first pass was successful in 133 (88.7%). These results are better than those of blind placement techniques reported in the literature. The only complications were hematoma and carotid puncture, which both occurred in the same two patients (1.3%). There was no significant difference among the radiologists in the number of passes needed (one-way analysis of variance, p > 0.05). The number of passes was independent of anatomic factors, including depth from skin, vein diameter or relative location. However, significantly more passes were needed for left-side punctures than for right-side punctures (Student t-test, p < 0.05).


CONCLUSIONS
Real-time ultrasound monitoring is superior to blind techniques in cannulation of the internal jugular vein because of its ease, accuracy and safety. Sonographic real-time monitoring minimizes the impact of anatomic factors on success and complication rates. It is a safe and efficacious approach that should be preferred in the placement of central lines.
Docktor
B
B
Department of Diagnostic Imaging, University of Calgary Medical School, AB.
So
C B
CB
Saliken
J C
JC
Gray
R R
RR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D011677:Punctures; D015642:Radiology, Interventional; D012867:Skin; D018084:Ultrasonography, Interventional / Q000379:methods; D014636:Valsalva Maneuver