Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein

Context: Real-time ultrasound guidance for internal jugular (IJ) vein cannulation enhances safety and success. Aims: This study aims to compare the long- and short-axis (LA and SA) approaches for ultrasound-guided IJ vein cannulation. Subjects and Methods: Patients undergoing surgery and in intensive care unit requiring central venous cannulation were randomized to undergo either LA or SA ultrasound-guided cannulation of the IJ vein by a skilled anesthesiologist. First pass success, the number of needle passes, time required for insertion of guidewire, and complications were documented for each procedure. Results: The IJ vein was successfully cannulated in all patients. There are no significant differences between the two groups in terms of gender, diameter of IJ vein, margin of safety, and time required for insertion of guidewire. There was also no significant difference between the two groups in terms of side of IJ vein cannulated, patient on mechanical ventilation, number of skin puncture, number of needle redirections, first pass success, and carotid puncture. However, there is a significant relationship between the diameter of IJ vein with first pass (18.18 4.72 vs. 15.21 4.24; P < 0.004) and margin of safety with of incidence of carotid puncture (12.15 4.03 vs. 6.59 3.13; P < 0.016). Conclusions: Both techniques have similar outcomes when used for IJ vein cannulation.