Ultrasonography Assisted Internal Jugular Central Vein Catheterization in the Emergency Department: Comparison of Methods

Lee, Dae Wook; Kim, Ki Hwan; Lee, Myung Gab; Cho, Young Soon; Kim, Ho Jung; Lim, Hoon

Abstract

PURPOSE: The purpose of this study was to determine whether ultrasonography assisted internal jugular central venous catheterization by single operator or two-operator could improve the success rate and decrease the number of complications compared to the traditional landmark technique.
METHODS
This study was a prospective, randomized, clinical trial conducted from July 2008 to February 2009 in an urban Korean teaching hospital. Patients requiring central venous access were randomized to 1 of the 3 insertion techniques (single-operator technique, two-operator technique, traditional landmark technique). The primary outcome measure was cannulation success. Additional outcome measures included number of attempts, access times, and complications.
RESULTS
One hundred fourteen patients were enrolled. Thirty four of 37(91.9%) internal jugular vein catheters were successfully inserted by single-operator technique, 34 of 39(87.2%) by two-operator technique and 22 of 38(57.9%) by landmark technique. First attempt cannulation was successful in 28 of 34(82.4%) using single-operator technique, 26 of 34(76.9%) using two-operator technique and 9 of 22(40.9%) using landmark technique. The median start to venipuncture time was 138 seconds by single-operator technique, 170 seconds by two-operator technique and 329 seconds by landmark technique. There were 19 complications in the study, 15 in the landmark group, 2 in the singleoperator group, and 2 in the two-operator group.
CONCLUSION
Real-time ultrasonography assisted internal jugular vein catheterization has an higher success rate, is less time consuming, and has a lower complication rate. The single-operator technique appears to be equivalent to the two-operator technique in success rate and procedure time.