# A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided

## TL;DR

This study compares three methods for inserting a catheter into the internal jugular vein and finds that real-time ultrasound guidance has the highest first-attempt success rate.

## Contribution

The study provides a direct comparison of success rates and complications among three IJV cannulation techniques in a randomized controlled trial.

## Key findings

- Real-time ultrasound guidance had the highest first-attempt success rate (83.6%) compared to other techniques.
- No major complications were observed across all three techniques.
- Overall procedure time was similar among the three methods.

## Abstract

Objective: The objective of our study is to compare the success rate, duration, and incidence of complications of a right internal jugular vein (IJV) cannulation by using three different techniques.

Methodology: A randomised controlled trial was conducted at a tertiary care teaching hospital. A total of 201 patients were randomly allocated to one of the following three groups (67 in each group). Techniques were categorised as anatomical landmark technique group (Group ALT), ultrasound guided pre-location group (Group USG-Pre), and real-time ultrasound-guided technique group (Group USG-RT).

Interventions: Central venous catheter insertion via three techniques.

Results: In 138 (73.01%) patients’ IJV canulated in the first attempt, USG-RT, USG-Pre, and ALT were 51 (83.6%), 44 (72.1%), and 43 (64.2%), respectively. On the other hand, 37 (19.57%) patients were required in the second attempt, while only 14 (7.40%) patients were required in the third attempt for successful IJV cannulation. The success rates, as defined in our study, were only 138 (73%) as, in 51 (27%), we cannulated in more than a single attempt or switched to another technique. We found a significant difference in preparation time in all techniques as P-value <0.05, but no significant difference was found in venous access time, cannulation time, and duration of the procedure.

Conclusions: Any technique can be used for IJV cannulation, but the most acceptable is the real-time US technique. However, no difference in the overall procedure time among all three techniques was noted, and no major incidence of complication was found.