Journal of Medical Academics

Register      Login

VOLUME 4 , ISSUE 2 ( July-December, 2021 ) > List of Articles

RESEARCH ARTICLE

Comparison of Anterior and Posterior Approach of Percutaneous Catheterization of Internal Jugular Vein under Real Time Ultrasound Guidance in Critically Ill Patients: A Prospective Randomized Study

Tanya Mishra, Divya Garg

Keywords : Anterior approach, Critically ill patients, Posterior approach, Internal jugular vein cannulation, Ultrasound

Citation Information : Mishra T, Garg D. Comparison of Anterior and Posterior Approach of Percutaneous Catheterization of Internal Jugular Vein under Real Time Ultrasound Guidance in Critically Ill Patients: A Prospective Randomized Study. Journal of Medical Academics 2021; 4 (2):36-43.

DOI: 10.5005/jp-journals-11003-0106

License: CC BY-NC 4.0

Published Online: 22-10-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Central venous catheterization is a vital intervention in critically ill patients. The proper route of insertion is essential for its success. The purpose of this study was to compare the procedural parameters and complications associated with anterior and posterior approaches to internal jugular vein catheterization under real-time ultrasound guidance in critically ill patients. Materials and methods: In this prospective randomized study, 90 patients admitted in various ICUs were randomly allocated two groups of 45 each, including both males and females aged between 18 and 80 years of age requiring central venous catheterization for various indications. Demographic data was comparable between both groups. The first attempt success rates, venous visualization time, venous puncture time, duration of catheterization, and complications of each route were compared. Results: The first attempt success rates were comparable between both groups. The venous visualization time was 38.52 seconds in group I and 14.65 seconds in group II (p < 0.001). The venous puncture time and the duration of catheterization was found to be 47.60 sec and 2 minutes in group I, respectively, and 24.16 sec and 1 minute 32 sec in group II, respectively (p < 0.001). No statistically significant differences were found between the two groups in terms of incidence of carotid arterial puncture, hematoma formation, and catheter displacement. Conclusion: It was concluded that the posterior approach is better than the anterior approach of ultrasonogram (USG) guided internal jugular vein catheterization as it improves the accuracy, reduces the access time and duration of catheterization, and fewer incidences of immediate complications like carotid arterial puncture and hematoma formation.


PDF Share
  1. Williams PL, Warwick R, Dyson M, et al. Gray's Anatomy, 37th edition, New York: Churchill Livingstone; 1989;795–796.
  2. Lee McGregor A, Decker GAG, du Plessis DJ. Lee McGregor's synopsis of Surgical Anatomy, 12th Edition, Bristol: John Wright and Sons; 1980;253–254.
  3. Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med 2002;30(2):454–460. DOI: 10.1097/00003246-200202000-00031
  4. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomised controlled trial. JAMA 2001;286(6):700–707. DOI: 10.1001/jama.286.6.700
  5. Guidance on the use of ultrasound locating devices for placing central venous catheters | Guidance and guidelines | NICE.
  6. Legler D, Nugent M. Doppler localization of the internal jugular vein facilitates central venous cannulation. Anesthesiology 1984;60(5):481–482. DOI: 10.1097/00000542-198405000-00016
  7. Denys BG, Uretsky BF, Reddy PS. Ultrasound assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark guided technique. Circulation 1993;87(5):1557–1562. DOI: 10.1161/01.cir.87.5.1557
  8. Slama M, Novara A, Safavian A, et al. Improvement of internal jugular vein cannulation using an ultrasound guided technique. Intensive Care Med 1997;23(8):916–919. DOI: 10.1007/s001340050432
  9. Chowdhary LS, Karmakar US, Dixit RT, et al. Comparison of two different approaches for internal jugular vein cannulation in surgical patients. J Postgrad Med 1998;44(3):57–62.
  10. Mohan Chandralekha V, Darlong V, Kashyap L. Internal jugular vein cannulation- comparison of central approach and posterior approach. Eur J Anaesthesiol 2005;22:197–198. DOI: 10.1097/00003643-200505001-00713
  11. Sindhu S, Sethi N, Sehgal R, et al. Evaluation of posterior approach for IJV cannulation: our experience. J Anaesth Clin Pharmacol 2008;24(2):193–196.
  12. Perez Reyes JM, Bethencourt Munoz S, Cabrejas Ibarz MT, et al. Ultrasound guided puncture of the jugular vein using a posterior approach. Rev Esp Anestesiol Reanim 2008;55(10):616–620. DOI: 10.1016/s0034-9356(08)70673-x
  13. Turker G, Kaya FN, Gurbet A, et al. Internal jugular vein cannulation: an ultrasound guided technique versus a landmark guided technique. Clinics (Sao Paulo) 2009;64(10):989–992. DOI: 10.1590/S1807-59322009001000009
  14. Chandrasekharan S, Chandrasekharan VP. Anatomical variations of the internal jugular vein in relation to common carotid artery in lesser supraclavicular fossa- a color Doppler study. International Journal of Basic Medical Science 2011;2(4).
  15. Lamkinsi T, Kettani A, Belkhadir Z, et al. Internal jugular venous catheterization: what is the best approach? Annales Francaises d’Anesthesie et de Reanim 2012;31(6):512–516. DOI: 10.1016/j.annfar.2012.01.024
  16. Tammam TF, El-Shafey EM, Tammam HF. Ultrasound guided internal jugular vein access: comparison between short axis and long axis techniques. Saudi J Kidney Dis Transpl 2013;24(4):707–713. DOI: 10.4103/1319-2442.113861
  17. Rando K, Castelli J, Pratt JP, et al. Ultrasound-guided internal jugular vein catheterization: a randomized controlled trial. Heart, Lung and Vessels. Heart Lung Vessel 2014;6(1):13–23.
  18. Babu BVM, Rao ASK, Srikanth B. Comparision of posterior and anterior approaches for internal jugular venous cannulation- a prospective & randomised controlled study. Int J Sci Stud 2014;2(2):35–38.
  19. Song D, Yun S, Cho S. Posterior triangle approach for lateral in-plane technique during haemodialysis catheter insertion via the internal jugular vein. Ann Surg Treat Res 2015;88(2):114–117. DOI: 10.4174/astr.2015.88.2.114.
  20. Fathi M, Izanloo A, Jahanbakhsh S, et al. Central venous cannulation of the internal jugular vein using ultrasound-guided and anatomical landmark techniques. Anesth Pain Med 2016;6(3):e35803. DOI: 10.5812/aapm.35803
  21. Manjula BP, Deepthi HV. Internal jugular venous cannulation-comparision of anterior and posterior approach. J Evolution Med Dent Sci 2017;6(39):3143–3146.
  22. Pikwer A, Bååth L, Davidson B, et al. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients. Anaesth Intensive Care 2008;36(1):30–37. DOI: 10.1177/0310057X0803600106
  23. Verghese ST, McGill WA, Patel RI, et al. Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparision with the traditional palpation method. Anesthesiology 1999;91(1):71–77. DOI: 10.1097/00000542-199907000-00013
  24. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound guided catheterization of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. CritCare 2006;10(6):R162. DOI: 10.1186/cc5101
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.