Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development.
OBJECTIVE
The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach.


RESULTS
In recent years, several studies were published on the benefits of ultrasound use for central venous catheterization. This technique has evolved rapidly due to improvements in the equipment and technology available. Ultrasound helps to detect the anatomical variants of the internal jugular vein. The typical anterolateral position of the internal jugular vein with respect to the carotid is found in only 9-92% of cases. Ultrasound guidance reduces the rate of mechanical, infectious, and thrombotic complications by 57%, and it also reduces the failure rate by 86%. Cost-benefit analyses show that the cost of ultrasound equipment is compensated by the decrease in the expenses associated with the treatment of complications. In this article, we will review the history of ultrasound guidance as well as the reasons that account for its superiority over the classical anatomical landmark technique. We will describe the equipment needed for central venous catheterization as well as the various methods to visualize with ultrasound.


CONCLUSIONS
To improve patient safety, we recommend the use of ultrasound for central venous catheterization using the internal jugular approach.
Ayoub
Christian
C
Département d'anesthésiologie, Département d'anesthésiologie et centre de recherche, Institut de Cardiologie de Montréal, Université de Montréal, 5000 Rue Bélanger, Montreal, QC, H1T 1C8, Canada. cr.ayoub@umontreal.ca
Lavallée
Catherine
C
Denault
André
A
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D007239:Infections / Q000209:etiology; D007601:Jugular Veins / Q000000981:diagnostic imaging; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D018084:Ultrasonography, Interventional / Q000191:economics / Q000379:methods*