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Real-time Ultrasound-Guided Catheterization of the Internal Jugular Vein: A Prospective Comparison

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Introduction: Conventionally central venous catheter is done utilising landmark technique. With increased availability of portable USG units, USG-guided intervention is fast gaining acceptance as a valuable tool in the critical-care setting. We designed this study to compare two methods of CVC insertion in terms of time taken, number of attempts, success rate and incidence of complications. This study will help us evaluate real time ultrasound in comparison to landmark technique. Material and Methods: 100 ASA I and II patients of either sex of ≥ 18 years of age, admitted to ICU or underwent surgery, requiring CVC placement were included in the study. Patients were randomly divided into two groups. Primary outcome measures were Successful insertion of a CVC. Secondary outcomes were (a.) Number of attempts for successful insertion of CVC (b.)Time taken to insert, (c.) Failure rate in insertion (d.) Incidence of complications. Result: The study was conducted in patients with a variety of disease processes. The distribution of age and sex was comparable in both the groups. Success rate was more in case of USG guided CVC insertion than landmark technique. In landmark technique successful cannulation was done in 86% patients vs 98% in USG group. The time taken during the procedure between group A (landmark technique ) was 42.59 ± 16.54 seconds which was higher than the time taken to catheterised by ultrasound guided technique 16.69 ± 9.80 seconds. p value was found to be less than 0.001, which was statistically significant. In group A incidence of hematoma formation was 14% and intra-arterial insertion of needle was 6% out of 20% overall complications. In group B incidence of hematoma formation was 8% and intra-arterial cannulation was 2% out of overall 10% complications. It was found that overall complication was more in group A patients than group B patients. But P value was found to be 0.161, and was statistically not significant. Conclusion: Considering the findings of the study, we concluded that USG guided CVC insertion has a better success rate, less failure, required less number of attempt and time taken to insert the CVC was significantly less. However, there was less complication with USG guided CVC insertion in present study, but it did not achieve statistical significance

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Introduction: Conventionally central venous catheter is done utilising landmark technique. With increased availability of portable USG units, USG-guided intervention is fast gaining acceptance as a valuable tool in the critical-care setting. We designed this study to compare two methods of CVC insertion in terms of time taken, number of attempts, success rate and incidence of complications. This study will help us evaluate real time ultrasound in comparison to landmark technique. Material and Methods: 100 ASA I and II patients of either sex of ≥ 18 years of age, admitted to ICU or underwent surgery, requiring CVC placement were included in the study. Patients were randomly divided into two groups. Primary outcome measures were Successful insertion of a CVC. Secondary outcomes were (a.) Number of attempts for successful insertion of CVC (b.)Time taken to insert, (c.) Failure rate in insertion (d.) Incidence of complications. Result: The study was conducted in patients with a variety of disease processes. The distribution of age and sex was comparable in both the groups. Success rate was more in case of USG guided CVC insertion than landmark technique. In landmark technique successful cannulation was done in 86% patients vs 98% in USG group. The time taken during the procedure between group A (landmark technique ) was 42.59 ± 16.54 seconds which was higher than the time taken to catheterised by ultrasound guided technique 16.69 ± 9.80 seconds. p value was found to be less than 0.001, which was statistically significant. In group A incidence of hematoma formation was 14% and intra-arterial insertion of needle was 6% out of 20% overall complications. In group B incidence of hematoma formation was 8% and intra-arterial cannulation was 2% out of overall 10% complications. It was found that overall complication was more in group A patients than group B patients. But P value was found to be 0.161, and was statistically not significant. Conclusion: Considering the findings of the study, we concluded that USG guided CVC insertion has a better success rate, less failure, required less number of attempt and time taken to insert the CVC was significantly less. However, there was less complication with USG guided CVC insertion in present study, but it did not achieve statistical significance

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This page is a summary of: Real-time Ultrasound-Guided Catheterization of the Internal Jugular Vein: A Prospective Comparison with the Landmark Technique, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6419.55.
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