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Ultrasound Guidance Improves the Success Rate of Internal Jugular Vein Cannulation: Materials and Methods

A Hewlett-Packard 7702A two-dimensional ultrasound unit with 5 Mil/ resolution was used. We affixed a 2.5-cni water hath standoff to a near-focus sinall-parts transducer. Because the ultrasound transducer had to he placed over the internal jugular vein in a sterile field, the transducer was wrapped in a sterile glove using the Following technique. A drop of ultrasonic conductive medium (povidone-iodine ointment) was placed on the contact surface of the transducer, after which sterile technique was used to place the transducer into the metacarpal-phalangeal region of a sterile surgical glove.
Sterile technique was then used to wrap a sterile surgical drape from the wrist area of the glove-enclosed transducer, and then proxinially along the transducer cable. The sterile glove and drape were secured with a Kelly clamp or needle-driver instrument. Sterile povidone-iodine ointment was then used as the ultrasound conductive medium between the sterile surgical glove and the patient s skin adjacent to the cannulation site, as shown in Figure 1.
All conscious patients who required urgent or urgent-elective internal jugular vein cannulation in the Id’ over a three-month period were approached for informed consent. Consenting patients were then prospectively randomized to receive either conventional (m\ surface and palpable landmark-guided), or real-time twodimensional ultrasound-guided cannulation attempts. A typical twodimensional ultrasound image is shown in Figure 2.
Patients who could not be cannulated during the initial five needle passes were then crossed over to receive the alternate technique for the next five passes. All cannulations were performed by either senior ICU staff or critical care fellows with at least six months of clinical experience in the ICl’.


Figure 1. Conventional two-dimensional ultrasound apparatus was easily modified for use on the sterile cannulation field.


Figure 2. This is a typical two-dimensional ultrasound image of the internal jugular vein (/y\0 in cross-section at a level just proximal to the clavicle. The cannulation needle {(irrotc) is traversing the deep margin of the sternocleidomastoid muscle (SCM) just prior to cannulation of the vein. CA, carotid artery.

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