Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients
1 Department of Intensive Care, General State Hospital of Athens, 154 Mesogeion Avenue, 11527 Athens, Greece
2 Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey, The University Hospital-150 Bergen Street Newark, NJ 07103 USA
3 Academic Medical Center, Department of Vascular Medicine, University of Amsterdam Tafelbergweg 51 .1105 BD Amsterdam, The Netherlands
4 Department of Cardiology, University Hospital of Heraklion, PO Box 1352 Stavrakia, Heraklion, Crete, Greece
5 2nd Department of Propedeutic Surgery, University of Athens School of Medicine, Laiko General Hospital, 17 Agiou Thoma street-11527 Athens, Greece
6 Department of Internal Medicine and Infectious Diseases, University of Crete, P. O. Box 2203, 71003 Heraklion, Greece
7 'J. Ioannovic' Burn Center, General State Hospital of Athens, 154 Mesogeion Avenue, 11527 Athens, Greece
8 1st Department of Propedeutic Surgery, University of Athens School of Medicine, Hipokrateion University Hospital,114 Vasilis Sofias Avenue 11527 Athens, Greece
Critical Care 2006, 10:R162 doi:10.1186/cc5101
See related commentary by Bodenham, http://ccforum.com/content/10/6/175Published: 17 November 2006
Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method.
In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index.
There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001).
The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients.