title: The success rate and safety of internal jugular vein cannulation using anatomical landmark technique in patients undergoing cardiothoracic surgery.
abstract: OBJECTIVE
  Landmark-guided internal jugular vein (IJV) cannulation is a basic procedure, which every anesthetist is expected to acquire. A successful first attempt is desirable as each attempt increases the risk of complications. The present study is an analysis of 976 IJV cannulations performed in adults undergoing cardiothoracic surgery.
  
  
  METHODS
  The IJV was cannulated with a triple lumen catheter using the anatomical landmarks. The following data were recorded: Patient demographics, age, sex, body mass index, diagnosis, operative procedure, operator (resident/consultant), site of cannulation (central approach, right IJV, left IJV, external jugular vein), number of attempts and duration of cannulation, length of insertion of the catheter, number of correct placements on X-ray and any complications.
  
  
  RESULTS
  The success rate of IJV cannulation was 100%. In 809 (82.9%) patients, cannulation was performed in the first attempt. Residents performed 792 cannulations and the consultants performed 184 cannulations. In 767 patients, the residents were successful in inserting the catheter and in 25 they failed after 5 attempts, hence, they were cannulated by the consultant. The time taken for insertion of the catheter was 6.89 ± 3.2 minutes. Carotid artery puncture was the most common complication, it occurred in 22 (2.3%) patients.
  
  
  CONCLUSIONS
  IJV cannulation with landmark technique is highly successful with minimal complications in the adult patients undergoing cardiothoracic surgery. Basic training of cannulating the IJV by landmark technique should be imparted to all the traines as ultrasound may not be available in all locations.
authors.affiliation: Department of Anaesthesiology and Intensive Care, G. B. Pant Hospital, New Delhi, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Tempe
authors.forename: Sanjula
authors.initials: S
authors.lastname: Virmani
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Agarwal
authors.forename: Manisha
authors.initials: M
authors.lastname: Hemrajani
authors.forename: Subodh
authors.initials: S
authors.lastname: Satyarthy
authors.forename: Harpreet Singh
authors.initials: HS
authors.lastname: Minhas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D020212:Carotid Artery Injuries / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006351:Heart Valves / Q000601:surgery; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology*; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D055815:Young Adult