A Comparison Of Central Versus Posterior Approach To Internal Jugular Vein Cannulation- A One Year Hospital Based Randomised Controlled Trial

Abstract

Background: Among the different large veins that can be cannulated the right internal jugular vein (IJV) is most preferred. Cannulation of the right IJV is most commonly done using the landmark guided central approach. It is associated with a higher risk of carotid puncture. In this context the posterior approach has been found to be better and safer. Objective: To compare the placement of an internal jugular central venous catheter via central versus posterior approach in terms of attempts and time to locate the vein, duration of cannulation and complications. Methods: A total of 120 adult patients were divided into two groups of 60 each to be cannulated by either the central or the posterior approach. Central approach the needle entry was at the apex of the sedilott’s triangle towards the ipsilateral nipple while in the posterior approach entry was along the lateral border of sternocleidomastoid muscle where it is crossed by the external jugular vein directed towards the sternal notch. Success rate and time taken to locate IJV, time taken for cannulation, number of carotid punctures and other complications were assessed. Results: Our analysis showed that in the posterior approach group the vein was located faster (12.04±1.49s vs 14.27±2.30s, p<0.001) and with fewer attempts (51(85%) vs 42(70%), p=0.054), both statistically significant. The duration of cannulation was also shorter with the posterior approach (205.54±29.58s vs 278.51±41.14s, p<0.001). Arterial punctures were more with the central approach (13 vs 3, p<0.001), instances of hematoma and catheter malposition were not statistically significant and no instances of pneumothorax were observed. Conclusion: The posterior approach has a higher first attempt success rate, shorter duration of cannulation and lower incidence of complications. It is a viable and efficient alternative to the central approach but involves a small learning curve.