title: Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound.
abstract: OBJECTIVE
  The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique.
  
  
  METHODS
  One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded.
  
  
  RESULTS
  Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B.
  
  
  CONCLUSIONS
  Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation.
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Shrikanth
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Govil
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Sweta
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: K N
authors.initials: KN
authors.lastname: Jagadeesh
authors.affiliation: Department of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Deeksha Singh
authors.initials: DS
authors.lastname: Tomar
keywords: Jugular vein; posterior venous wall penetration; real-time ultrasound