Retrospective comparison of two different approaches for ultrasound-guided internal jugular vein cannulation in hemodialysis patients

Background: Prevalent hemodialysis patients with vascular access consisting of a central venous catheter (CVC) are continuously increasing over the years. Improvement in evolution and CVC placement procedures represents therefore an essential tool to enhance performance and reduce intraoperative and long-term CVC complications. Internal jugular vein (IJV) catheterization techniques are different according to ultrasound probe position in relation to vein axis and to needle direction in relation to ultrasound beam. Lateral in-plane (LIP) approach has been proposed to be advantageous compared to traditional anterior out-of-plane (AOP) technique. Methods: In this retrospective nonrandomized study we evaluated outcomes of 337 hemodialysis CVCs positioned in our center (Dono Svizzero Hospital) between 2011 and 2016, 237 using the AOP technique and 100 using the LIP approach. Results: We found no significant differences among considered outcomes (procedure success, arterial puncture, pneumothorax, first-use malfunction, kinking/pinching) between the two approaches. Conclusions: In our experience AOP and LIP approaches have shown the same outcomes. However, we believe that the LIP technique has potential benefits and it should be considered in the decision process of IJV cannulation.