A prospective randomized study to compare short axis and long axis techniques of ultrasound guided internal jugular vein catheterizations

Abstract

Context: Central venous catheterization (CVC) is integral part of management in modern era. Studies have compared different approaches of Ultrasound guided CVC, but still inconclusive. Aims: Comparing ultrasound guided CVC techniques, short vs long axis, for novice ultrasound operator with respect to successful cannulation (SC), venous access time (VAT), attempts, cannulation time (CT) and complications. Design: Prospective, randomized, comparative study. Methods and Material: Study includes 60 patients >18 years, requiring CVC, undergoing surgery under general anaesthesia. Ipsilateral Internal Jugular Vein (IJV) cannulation in past 72 hours, ipsilateral AV fistula, coagulopathy, IJV thrombosis, subcutaneous hematoma/emphysema, infection, erosion and previous surgical intervention at or near puncture site were excluded. Two groups, Long (L) and Short (S) Axis, formed using random number table. Single anaesthetist novice ultrasound operator performed cannulation. Statistical analysis used: SPSS17.0 version used. Student’s T test and Mann Whitney U test used for continuous variables. Nominal categorical data compared using Chi-square and Fisher’s exact test. p<0.05 considered statistically significant.Results: Demography and clinical characteristics were comparable. SC in S group (86.7%) was comparable to ‘L’ group (80%). VAT in ‘S’ and ‘L’ groups was 49.73+/-19.87 and 52.5+/-19.7 respectively. Two patients in ‘S’ while 5 in ‘L’ group required >3 cannulation attempts. CT in both groups was comparable (P=0.928). Complication rate was higher in ‘L’ (13.3%) vs ‘S’ group (3.3%). Conclusions: Short and long axis approaches of ultrasound guided IJV catheterization are comparable in terms of SC, attempts, VAT, CT and complications. Further multi-centric trials with larger cohort are needed.