A 3-year experience of ultrasound-guided catheterization of internal jugular vein in an intensive care unit (ICU)

Introduction

Ultrasound-guided catheterization of the internal jugular vein has proved to be of benefit especially for patients with specific problems such as those hospitalized in ICUs. Our purpose was to evaluate the usefulness of such a method compared with the landmarks method, when the former is performed by a senior intensivist trained in ultrasound for 1 year and recently taught the Doppler guidance method and the latter by experienced staff.

Patients and methods

A prospective randomized study was performed during a 3-year period, in the 12-bed multidisciplinary ICU of 'G. Gennimatas' General Hospital (1 November 2000 – 1 November 2003). One group was assigned to internal jugular vein cannulation by the landmarks method (control group) and the other with ultrasound guidance (ultrasound group).

Measurements and results

Sixty-six patients (17 women and 49 men) were examined. Thirty-five patients were submitted to catheterization with the landmarks method and 31 patients with ultrasound guidance. Internal jugular vein cannulation was successful in 29 cases (82.8%) in the control group and in 30 cases (96.7%) of the ultrasound group (P = 0.07). Carotid artery puncture occurred in two cases in the first group and in one case in the second (P = 0.80). Jugular cannulation was successful at the first attempt in 74.2% and 86.6% of cases in the first and second group correspondingly (P = 0.25). The average access time was longer in the control group (9.33 s vs 6.85 s in the ultrasound group).

Conclusion

Ultrasound guidance improved the success rate of jugular vein cannulation and reduced the number of failures and complications as well as the number of attempts, but the difference between the two methods was not significant. The familiarity of the operators with the method is probably a contributing factor and must be taken into account.