• D L Mallory, W T McGee, T H Shawker, M Brenner, K R Bailey, R G Evans, M M Parker, J C Farmer, and J E Parillo.
• Department of Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda, MD.
• Chest. 1990 Jul 1;98(1):157-60.

Study ObjectiveTo compare conventional versus ultrasound-guided internal jugular vein cannulation techniques.DesignPatients were randomly assigned to receive either conventional or two-dimensional ultrasound-guided internal jugular vein cannulation. Patients who could not be cannulated with five or fewer passes by either technique, were crossed over to the other technique.SettingClinical research unit in a tertiary care center.PatientsAll consecutive patients who required urgent or urgent-elective internal jugular vein cannulation during the study period.InterventionsThe two-dimensional ultrasound transducer imaged all cannulation attempts. For patients randomized to ultrasound guidance, the operator viewed two-dimensional ultrasound images, and received verbal guidance from the ultrasound technician. For patients randomized to the conventional arm, two-dimensional ultrasound images were recorded without visual or verbal feedback.Measurements And Main ResultsTwo-dimensional ultrasound was significantly better than conventional guidance in reducing the number of failed site cannulations from 6/17 (35 percent), to 0/12 (0 percent), p less than 0.05. Two-dimensional ultrasound also reduced the mean number of passes required to cannulate the vein from 3.12 to 1.75 (p less than .05), and was also successful in six/six (100) of patients who failed cannulation by conventional means (p less than 0.05).ConclusionsIntensivists can increase successful internal jugular vein cannulation using ultrasound guidance. Two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.

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