Comparison of catheterization of internal jugular vein by ultrasound guided versus landmark approach IN I.C.U. patients

Introduction: Central venous line placement is one of the essential procedures in the treatment of critically ill patients admitted in the intensive care unit. Central venous catheterization is required not only for providing a route for delivery of the caustic or critical medications but it also allows for the measurement of central venous pressure. Being an invasive procedure it has a learning curve and is associated with many complications. Hence, we conducted the study comparing catheterization of internal jugular vein by ultrasound guided versus landmark approach, with respect to the ease of insertion and related complications in Intensive Care Unit (I.C.U.) patients. Materials and Methods: 150 patients admitted in the I.C.U, fulfilling the inclusion criteria were divided into two groups based on computer generated randomization table namely: group A (landmark technique) and group B (USG technique) comprising of 75 patients in each group. In landmark approach, the internal jugular vein was located at the apex of triangle formed by the sterna and clavicular heads of sternocleidomastoid muscle and needle was directed towards the ipsilateral nipple when advanced through skin, lateral to the carotid artery pulsations with artery being pushed medially. In USG guided approach, the linear USG probe of 7 MHz connected to a real-time Kontron Medical ultrasound unit, was used with standard two-dimensional (2D) ultrasound imaging to identify the IJV. Catheterization was performed real-time by placing the transducer of the ultrasound parallel and superior to clavicle, over the groove between the two heads of the sternocleidomastoid muscle (SAX view). A post-procedure x-ray of chest was done as early as possible to assess the placement of CVC and rule out any complication. Results: The two groups were comparable in age, sex and body mass index. There was no statistically significant difference in the mean number of attempts taken for catheterization of IJV between the two groups (p-value=0.124). However, the mean time taken for cannulation of IJV was found to be significantly lower in the USG group as compared to the landmark group (p-value=0.03). The overall rate of complications was significantly higher in group A (p=0.012). Conclusion: Ultrasonography guidance significantly reduced the total procedural time and the rate of complications during internal jugular vein cannulation compared to the landmark technique.