Internal Jugular Vein is commonly cannulated to obtain central venous access for long term administration of vasopressors, irritant drugs, fluids, haemodynamic monitoring, total parenteral nutrition and haemodialysis in critical care patients.  The safe puncture of internal jugular vein can be achieved using anatomical landmarks in the neck. Ultrasound guidance could be beneficial in placing central venous catheters by improving the success rate, reducing the number of needle passes and decreasing the access time. The present study observed the cannulation techniques of internal jugular vein by anatomical landmark and real-time ultrasound guided techniques and compared whether the use of ultrasound improves the rapidity of the cannulation technique. In this study, hundred critical care patients requiring right internal jugular vein cannulation via central approach were allocated to one of the two groups- anatomical landmark guided or real-time ultrasound guided group (50 in each group) based on the technique of cannulation. In our study, there was 86% success rate for first attempt cannulation in the ultrasound guided technique and 68% in the anatomical landmark guided technique. The mean total time of cannulation in the ultrasound guided technique was 150.68 ± 16.93 sec as against 221.20 ± 61.91 sec in the anatomical landmark guided technique. Ultrasound guided technique improves the catheterization technique of the internal jugular vein with respect to rapidity and success rate of the procedure.

Keywords: Central venous cannulation, Internal Jugular Vein, Real-time ultrasound, Anatomical landmark.

1. Marano L, Izzo G, Esposito G, et al. Peripherally inserted central catheter tip position: a novel empirical-ultrasonographical index in a modern surgical oncology department. Ann Surg Oncol. 2014; 21: 656-661
2. Duffy BJ J. The clinical use of polyethylene tubing for intravenous therapy; A report on 72 cases. Ann. Surg.1949; 130(5):929-936 .
3. Andrew R. Webb, Marc J. Sharpiro, Meryn Singer: Oxford textbook of Critical Care, Oxford Medical Publications 1990: 1090 – 1094.
4. Robert R   Kirby:   Critical   Care, 2nd   edition, J.B.Lippincott Company, Philadelphia, 1992, 149-168.
5. Douglas L Mallory, Shawker TH, Evans RG, et al: Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation: Crit Care Med,1990; Vol 18;1269-1273.
6. Ray J Defalque, MD. Percutaneous catheterization of the Internal Jugular Vein. Anaesth Analg Cur Res; Jan - Feb 1974; Vol.53(1): 116 – 121
7. J. Alderson, F. A. Burrows, L. I. Stemp, H. M. Holtby. Use of ultrasound to evaluate Internal    Jugular    Vein    anatomy    and    to    facilitate    central venous cannulation in pediatric patients. Br J Anaesth 1993; 70: 145 – 148
8. Dimitrios Karakisos, Nicolas Labropoulos, Eric De Groot, Alexandros P P, Gregorios Kauraksis, John Poulasas et al. Real time Ultrasound guided catheterization of Internal Jugular vein - A prospective comparison with the land mark technique in critical care patients. J Critical Care 2007; Vol 10(6): 843 – 863
9. Piero Antonio Conz, Daniela Dissegna, Maria Pia Rodighero, Giuseppe La Greca. Cannulation of Internal Jugular vein - Comparison of classical Seldinger technique and ultrasound guided method. J Nephrology 1997; Vol 10(6): 311 – 313
10. Wg Cdr R. M. Sharma, Col C.V.R. Mohan, Lt Col R. Sethur, Wg Cdr H Sahani. Ultrasound guided central venous cannulation. Medical J Armed Forces of India 2006; 62: 371 – 372
11. Testa A., Biasucci D.G., La Greca, Pittiruti M, Portale G, Pignataro G, et al. Ultrasound guided central venous cannulation versus the land mark guided technique. J Annals of Emergency Medicine 2004; 11: 582 - 585
12. Bart G Denys, MD, Barry F Uretsky, MD, P Sudhakar Reddy, MD. Ultrasound Assisted Cannulation of the Internal Jugular Vein. Circulation May 1993; 87(5): 1557 – 1562
13. Daniel Duque, Stuart Kessler. Ultrasound guided vascular access. J Intensive Care Medicine 1997; 23: 916 – 919
14. Hasan Dolu, Sıtkı Goksu, Levent Sahin, Onder Ozen, Levent Eken. Comparison of an ultrasound-guided technique versus landmark-guided technique for internal jugular vein cannulation. Journal of Clinical Monitoring and Computing; February 2015, Volume 29, Issue 1: 177–182
15. Turker G, Kaya FN, Gurbet A, Aksu H, Erdogan C, Atlas A. Internal jugular vein cannulation: An ultrasound-guided technique versus a landmark guided technique. Clinics. 2009; 64(10): 989-992

Dr Geetha N.K.

Additional Professor, Department of Anaesthesiology, Govt Medical College, Thiruvananthapuram, Kerala, India

Ph: 9447745863, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.