Ultrasound guided internal jugular vein cannulation with short and long axis approach-Technical ease and complications

Central venous cannulation is commonly performed procedure on critically ill patients. Of the two methods, landmark technique and ultrasound (USG) guided latter increases success rate and decreases complications associated with the procedure.

Ultrasound guided cannulation can be done in short or long axis approach. In the short axis approach, both artery and vein can be simultaneously viewed and hence would have less chances of arterial puncture. In the long axis approach only one vessel and the entire length of the needle is visualized and therefore there would be less chances of posterior wall puncture. In this prospective randomized observational study USG guided internal jugular vein (IJV) cannulation was done by trainees (post graduate students). The aim of this study was to find the incidence of successful cannulation and incidence of complications by short and long axis approach.

Fifty patients were randomly allocated into two groups, short axis and long axis. All the patients were cannulated by Seldinger technique and free flow of blood was confirmed through all the ports.

Demographic variables were comparable between the two groups. On first attempt 92% of patients in long axis and 76% of patients in short axis were cannulated. In both the groups, remaining patients were cannulated on second attempt and large number of patients had arrhythmias. Four patients had arterial puncture in short axis group but none was seen in long axis group.

All patients were successfully cannulated. Higher first attempt successful cannulation and overall less complication were seen in long axis approach but the difference was not statistically significant.