Anterior approach internal jugular vein catheterization

Background

Internal jugular vein cannulation has become one of the most commonly attempted central lines used in the operation rooms as well as in critically ill patients. There are three approaches to the internal jugular vein (posterior, conventional, and anterior)

Methods

We randomly studied 60 patients who underwent percutaneous internal jugular vein cannulation with the supra-clavicular (anterior) approach (30 patients) or the conventional internal jugular approach (30 patients). The parameters observed included success rates, complications, flow and waveform characteristics and the acceptability of the technique both to the operator and the patient.

Results

There were no significant differences between the two groups. First-attempt success and failure was the same in the two groups. Easiness for the operator was higher in the supraclavicular approach (P = 0.02). The number of complications (arterial puncture [3-2], pneumothorax [0-0], hemothorax [0-0]) were not different in the two groups. There were two significant differences in flow and waveform characteristics between the two groups. However, the supraclavicular approach was associated with greater patient comfort (P < 0.00001) but difficult fixation. Kinking in CXR in the ICU was higher in the supraclavicular group (P < 0.0001).

Conclusion

We recommend the supraclavicular approach for CVP line placement in the internal jugular vein in cardiac surgery for experienced cardiac anesthesiologists.