Combined Short-Long Axis Versus Medial Oblique Axis for Internal Jugular Vein Cannulation: A Prospective Single-Blinded Randomized Clinical Trial.

Abstract

Objective(s): Previous literature suggested the advantage of combined short-long axis (CSLA) technique to avoid posterior wall puncture during internal jugular vein (IJV) cannulation. The purpose of this study is to define the best ultrasound-guided IJV cannulation technique regarding the success rate in the first trial of insertion, time to successful central line placement, number of attempts, procedural complications, and operator satisfaction.

Design: Single-blinded, prospective randomized clinical trial.

Setting: Elective cardiac surgeries in a tertiary care center.

Participants: One hundred seventy-eight elective cardiac surgery patients older than 18 years accepted to participate in the study and signed the informed consent.

Interventions: Patients were randomized into two equal groups: medial oblique axis and CSLA. During the technique, vein dimensions, patient characteristics, technique duration, posterior wall puncture, number of attempts, complications, and operator satisfaction were documented.

Measurements and main results: Apart from body weight, there were no significant differences in baseline characteristics between both groups. Compared to the CSLA, the medial oblique approach showed significantly higher first-trial success rate (92.1% v 75.0%, p = 0.002), less time for successful insertion (mean ± SD, 60.9 ± 54.9 seconds v 110.7 ± 101.6 seconds, p < 0.001), accomplishment with fewer attempts (mean ± SD, 1.09 ± 0.28 v 1.44 ± 0.81, p < 0.001), and higher operator satisfaction (mean ± SD, 4.45 ± 0.92 v 3.46 ± 1.32, p < 0.001). No significant difference in complications, including posterior wall puncture (p = 0.469), was noted between both groups.

Conclusions: This study demonstrated the medial oblique axis approach was superior to the CSLA approach regarding first-trial success rate, time to successful line placement, number of attempts, and operator satisfaction when used during elective cannulation of the IJV. However, regarding the incidence of complications, there was no advantage of one approach over the other. Further research is needed to confirm these results among specific groups of operators, with awake patients and in emergent situations.