title: Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients.
abstract: BACKGROUND
  The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation.
  
  
  METHODS
  Prospective observational study performed at a single tertiary cardiac care center.
  
  
  METHODS
  255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients.
  
  
  METHODS
  Demographic and categorical data were analyzed using Student 't' test and chi- square test was used for qualitative variables.
  
  
  RESULTS
  The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P< 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P< 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients.
  
  
  CONCLUSIONS
  USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.
authors.affiliation: Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
authors.forename: Madan Mohan
authors.initials: MM
authors.lastname: Maddali
authors.affiliation: Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
authors.forename: Venkitaramanan
authors.initials: V
authors.lastname: Arun
authors.affiliation: Department of Anesthesia Specialty, Oman Medical Specialty Board, Muscat, Sultanate of Oman.
authors.forename: Al-Ajmi Ahmed
authors.initials: AA
authors.lastname: Wala
authors.affiliation: Department of Anesthesia and Adult Intensive Care, Royal Hospital, Muscat, Sultanate of Oman.
authors.forename: Maher Jaffer
authors.initials: MJ
authors.lastname: Al-Bahrani
authors.affiliation: Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
authors.forename: Cheskey Manoj
authors.initials: CM
authors.lastname: Jayatilaka
authors.affiliation: Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
authors.forename: Arora Ram
authors.initials: AR
authors.lastname: Nishant
mesh_terms: D015992:Body Mass Index; D006348:Cardiac Surgical Procedures; D020212:Carotid Artery Injuries / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures / Q000706:statistics & numerical data*; D018084:Ultrasonography, Interventional