[Cannulation of the internal jugular vein using 2 ultrasonic technics. A comparative controlled study]

Abstract

The internal jugular vein (IJV) is a common access route to the central venous system. Anatomical landmarks (group I) are normally used for localization of the IJV. We have compared this method with two other methods based on ultrasonic waves to identify the IJV and the carotid artery (CA) (even in atypical positions). We employed an ultrasound Doppler device in group II and a real-time ultrasonograph in group III. Central venous catheters were placed into the right IJV by the Seldinger technique. The IJV could be located in all patients with both ultrasound methods, but the course of the IJV could only be identified by ultrasonography. For this reason, the direction of the IJV was classified as "typical" in 80% of group I, in 85% of group II, but in only 45% of group III. No intergroup differences were found with respect to the number of punctures (mean value 1.6 +/- 0.83) and the incidence of complications. The time required to locate the site and direction of puncture increased with technical sophistication. There was, however, no difference in the total time for catheter placement, because puncture was performed faster when aided by sonography. In four patients in groups I and II, in whom attempts to puncture the IJV had not been successful, this could subsequently be achieved with ultrasonographic aid. One patient (group I) displayed a hematoma following inadvertent puncture of the CA. In one patient in group II the IJV and CA could not be distinguished as one was overlying the other. The echocamera provided improved localization of the IJV and the CA in comparison with the Doppler ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)