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Ultrasound Guidance Improves the Success Rate of Internal Jugular Vein Cannulation: Results (2)

Using conventional landmarks, seven of 17 (41 percent; 95 percent confidence interval: 18 to 67 percent) patients were cannulated w ith the first needle pass. Three often (30 percent; 95 percent confidence interval: 7 to 65 percent) patients were cannulated with the second needle pass, none of seven (0 percent; 95 percent confidence interval: 0 to 35 percent) were cannulated with the third needle pass, one of seven (14 percent; 95 percent confidence interval: 0.3 to 58 percent) was successfully cannulated with the fourth pass, and none of six (0 percent; 95 percent confidence interval: 0 to 39 percent) patients were cannulated w ith a fifth needle pass (Fig 4).
Using ultrasound guidance, cannulation success w ith each pass was seven of 12 (58 percent; 95 percent confidence interval: 25 to 85 percent on the first needle pass, two of five (40 percent; 95 percent confidence interval: 5 to 85 percent) w ith the second, two of three (67 percent; 95 percent confidence interval: 10 to 99 percent) with the third, and one of one (100 percent; 95 percent confidence interval: 0 to 100 percent) w ith the fourth needle pass (Fig 4). Twodimensional ultrasound also reduced the mean number of passes required to cannulate the vein from at least 3.12 to 1.75 (p<0.05, Mantel-Haenszel test). The mean of 3.12 understates the result because patients w ho could not be cannulated w ere not counted in the mean of this statistical comparison.

Figure-4

Figure 4. Cannulation success r.v consecutive needle thrusts. Using conventional (CONVENT) technique (broken line) the chance for successful cannulation tended to decrease with each attempted site. With two-dimensional ultrasound (2DUS) (solid line), a targeting effect occurred, with a tendency toward higher success rates at all sites; 95 percent confidence limits for each thrust art* as described in the text. The solid and broken lines represent first-order polynomial lines of best fit for two-dimensional and conventional ultrasound, respectively.

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