Central venous cannulation is necessary in most critically ill patients for urgent or life-saving indications including massive volume resuscitation, administration of vasopressor agents, monitoring central hemodynamic parameters, temporary transvenous pacemaker insertion and administration of total parenteral nutrition. Placement of central venous catheters is most difficult for patients who need it most urgently, particularly those in shock or who require vasopressor agents. Moreover, patients who require central venous catheters often have coagulopathies, a high susceptibility to infection, obesity, edema or unusually small habitus, all of which make cannulation more difficult.
Very few data are available regarding important technical aspects of successful internal jugular vein cannulation. There is no documented strategy to maximize success while minimizing risks and complications. Two studies have included success ratios at sequential sites, but do not include the number of percutaneous punctures or needle passes. Two studies also have included data which permit calculation of the number of thrusts necessary to cannulate the vein. M In order to clarify these important aspects of internal jugular vein cannulation, we used real-time two-dimensional ultrasound to prospectively study 29 patients who required urgent or urgent-elective internal jugular vein cannulation in the medical/surgical ICU.