Ultrasound-guided external jugular vein cannulation for central venous access by inexperienced trainees

Abstract

Background and objective: The insertion of central venous catheters via the external jugular vein (EJV) is not always practical because of the relatively frequent failure rate; thus, the internal jugular approach is generally used. Data from the literature suggest that ultrasound-guided catheterization of the internal jugular vein is superior to the surface anatomy landmark technique and, therefore, should be the method of choice. We evaluated the value of ultrasound guidance in the learning process of central venous cannulation via EJV by similarly inexperienced trainees.

Methods: In this prospective randomized study, 60 patients were assigned to two groups: group SA (surface anatomy; n = 30) underwent insertion of the central venous catheter using landmark guidance and group US (ultrasound; n = 30) underwent insertion using ultrasound guidance. In all patients, catheter insertion through the right EJV was performed by trainees in their second year of training. Ultrasound guidance was carried out by the same ultrasound specialist. The following parameters were evaluated in all patients: the number of successful punctures of the right EJV, the total number of attempts and the time to vein puncture; the number of successful insertions of the central venous catheter, the number of attempts and the duration of catheterization (from puncture of EJV to external fixation of the catheter); and the incidence of complications. The study was approved by the institutional ethics committee, and all patients gave written informed consent. Data were expressed as mean +/- SD. Student's t-test, Mann-Whitney test and chi2-test were used for analysis and P < 0.05 was considered statistically significant. The power of the study was 85%.

Results: The EJV puncture was successful in 24 out of 30 (80%) patients from group SA and in 22 out of 30 (73%) patients from group US (P = NS). There were no statistically significant differences between the groups regarding the mean time to perform the vein puncture and the number of attempts. The insertion of the central venous catheter was performed successfully in 10 (33%) patients from group SA and six (20%) patients from group US. The success rate of central cannulation via the EJV approach was 10 out of 24 (42%) in group SA and six out of 22 (27%) in group US (P = NS). The total time for insertion and the number of attempts were similar in both groups (P = NS). Local haematoma occurred in 11 patients in group SA and in three patients in group US (P = NS).

Conclusion: Our results demonstrate no significant differences between the conventional surface anatomy landmark technique and the ultrasound-guided technique for the insertion of a central venous catheter via EJV by inexperienced trainees.