Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial.

STUDY OBJECTIVE To compare conventional versus ultrasound-guided internal jugular vein cannulation techniques. DESIGN Patients were randomly assigned to receive either conventional or two-dimensional ultrasound-guided internal jugular vein cannulation. Patients who could not be cannulated with five or fewer passes by either technique, were crossed over to the other technique. SETTING Clinical research unit in a tertiary care center. PATIENTS All consecutive patients who required urgent or urgent-elective internal jugular vein cannulation during the study period. INTERVENTIONS The two-dimensional ultrasound transducer imaged all cannulation attempts. For patients randomized to ultrasound guidance, the operator viewed two-dimensional ultrasound images, and received verbal guidance from the ultrasound technician. For patients randomized to the conventional arm, two-dimensional ultrasound images were recorded without visual or verbal feedback. MEASUREMENTS AND MAIN RESULTS Two-dimensional ultrasound was significantly better than conventional guidance in reducing the number of failed site cannulations from 6/17 (35 percent), to 0/12 (0 percent), p less than 0.05. Two-dimensional ultrasound also reduced the mean number of passes required to cannulate the vein from 3.12 to 1.75 (p less than .05), and was also successful in six/six (100) of patients who failed cannulation by conventional means (p less than 0.05). CONCLUSIONS Intensivists can increase successful internal jugular vein cannulation using ultrasound guidance. Two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.