• John G Augoustides, David Diaz, Justin Weiner, Carmen Clarke, and David R Jobes.
• Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
• J. Cardiothorac. Vasc. Anesth. 2002 Oct 1;16(5):567-71.

ObjectiveTo describe current cannulation of the internal jugular vein (CIJV) practice in a university anesthesia department.DesignProspective, observational, and not randomized.SettingOperating rooms of the Hospital of the University of Pennsylvania.ParticipantsElective surgical patients requiring CIJV (n = 426).InterventionsCIJV performed by real-time ultrasound visualization (U-CIJV) or by anatomic landmarks (AL-CIJV).Measurements And Main ResultsA total of 462 procedures were studied in 426 patients. Overall cannulation failure was 2.1% with U-CIJV and 13.8% with AL-CIJV (p = 0.0001). Cumulative CIJV success by the sixth needle pass was 94.0%, regardless of technique. Junior operators performed 75.3% of CIJV, of which 86.8% was U-CIJV. First-pass success across operators was 60% to 70% for U-CIJV and 50% to 80% for AL-CIJV. Arterial puncture rates averaged 7.0%, regardless of technique (p = 0.45). The junior operator may be more at risk for arterial puncture during U-CIJV.ConclusionU-CIJV offers incomplete protection against arterial injury in this practice compared with the literature. A possible solution is the ultrasound needle guide, which may minimize arterial injury, especially with junior operators.Copyright 2002, Elsevier Science (USA). All rights reserved.

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