title: A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department.
abstract: OBJECTIVE
  The purpose of this study was to evaluate needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department, to determine cumulative cannulation success by method, to determine first-pass cannulation success by method and operator, and to determine arterial puncture by method and operator.
  
  
  METHODS
  Prospective, observational, and randomized. Blinding was not possible. Cohort size was calculated for 80% power to detect a technique difference, with significance defined as p < 0.05.
  
  
  METHODS
  Operating rooms of the Hospital of the University of Pennsylvania.
  
  
  METHODS
  Elective surgical patients requiring internal jugular venous cannulation.
  
  
  METHODS
  Cannulation of the internal jugular vein occurred by needle-guided ultrasound (NGU) or by ultrasound without a needle guide.
  
  
  RESULTS
  Four hundred thirty-four procedures were studied in 429 patients. NGU significantly enhances cannulation success after first (68.9%-80.9%, p = 0.0054) and second (80.0%-93.1%, p = 0.0001) needle passes. Cumulative cannulation success by the seventh needle pass is 100%, regardless of technique. The needle-guide specifically improves first-pass success in the junior operator (65.6%-79.8%, p = 0.0144). Arterial puncture averages 4.2%, regardless of technique (p > 0.05) or operator (p > 0.05).
  
  
  CONCLUSIONS
  Although the needle guide facilitates prompt cannulation with ultrasound in the novice operator, it offers no additional protection against arterial puncture. This may be because of a lack of control of needle depth rather than needle direction. A possible solution may be biplanar ultrasound for central venous cannulation.
authors.affiliation: Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, PA 19104, USA. yiandoc@hotmail.com
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Jiri
authors.initials: J
authors.lastname: Horak
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ochroch
authors.forename: William J
authors.initials: WJ
authors.lastname: Vernick
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gambone
authors.forename: Justin
authors.initials: J
authors.lastname: Weiner
authors.forename: Dawn
authors.initials: D
authors.lastname: Pinchasik
authors.forename: Deborah
authors.initials: D
authors.lastname: Kowalchuk
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Savino
authors.forename: David R
authors.initials: DR
authors.lastname: Jobes
mesh_terms: D000761:Anesthesia Department, Hospital; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D006785:Hospitals, University; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D009339:Needles; D011446:Prospective Studies; D014463:Ultrasonography