title: Current practice of internal jugular venous cannulation in a university anesthesia department: influence of operator experience on success of cannulation and arterial injury.
abstract: OBJECTIVE
  To describe current cannulation of the internal jugular vein (CIJV) practice in a university anesthesia department.
  
  
  METHODS
  Prospective, observational, and not randomized.
  
  
  METHODS
  Operating rooms of the Hospital of the University of Pennsylvania.
  
  
  METHODS
  Elective surgical patients requiring CIJV (n = 426).
  
  
  METHODS
  CIJV performed by real-time ultrasound visualization (U-CIJV) or by anatomic landmarks (AL-CIJV).
  
  
  RESULTS
  A total of 462 procedures were studied in 426 patients. Overall cannulation failure was 2.1% with U-CIJV and 13.8% with AL-CIJV (p = 0.0001). Cumulative CIJV success by the sixth needle pass was 94.0%, regardless of technique. Junior operators performed 75.3% of CIJV, of which 86.8% was U-CIJV. First-pass success across operators was 60% to 70% for U-CIJV and 50% to 80% for AL-CIJV. Arterial puncture rates averaged 7.0%, regardless of technique (p = 0.45). The junior operator may be more at risk for arterial puncture during U-CIJV.
  
  
  CONCLUSIONS
  U-CIJV offers incomplete protection against arterial injury in this practice compared with the literature. A possible solution is the ultrasound needle guide, which may minimize arterial injury, especially with junior operators.
authors.affiliation: Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: David
authors.initials: D
authors.lastname: Diaz
authors.forename: Justin
authors.initials: J
authors.lastname: Weiner
authors.forename: Carmen
authors.initials: C
authors.lastname: Clarke
authors.forename: David R
authors.initials: DR
authors.lastname: Jobes
mesh_terms: D001158:Arteries / Q000293:injuries; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011677:Punctures; D014463:Ultrasonography