A Comparative Study between Real-Time Ultrasound Guided Catheterisation of the Internal Jugular Vein with Landmark Technique in Critical Care Patients

Abstract

Objective: To compare the frequency of complications associated with real-time ultrasound-guided internal jugular vein (IJV) catheterization versus the classical landmark technique in critically ill patients.

Methods: This randomized controlled study was conducted in the Anesthesiology Surgical ICU Department of Peoples Medical University & Hospital, Nawabshah, from 3rd August 2020 to 2nd February 2021. A total of 182 patients were randomly allocated into two groups (Ultrasound Guidance = 91; Landmark Guidance = 91). Patients aged 18 to 70 years requiring central venous access for hemodynamic monitoring, administration of fluids/medications, total parenteral nutrition, hemodialysis, or inadequate peripheral access were included after informed consent. Patients with significant coagulopathy, local infection, structural obstruction of central veins, traumatic neck injury, or refusal to participate were excluded. All procedures were performed by trained ICU physicians. Access time, number of cannulation attempts, and procedure-related complications (carotid artery puncture, hematoma, arrhythmias, pneumothorax, hemothorax, nerve injury, and catheter malposition) were recorded. Data were analyzed using SPSS version 21.

Results: The mean age of participants was comparable in both groups (USG: 33.53 ± 11.32 years, LMG: 33.47 ± 11.37 years). Mean access time was significantly lower in the USG group (6.65 ± 2.36 min) than in the LMG group (8.80 ± 2.17 min). First-attempt success was higher in the USG group (83.5%) compared to the LMG group (79.1%). Carotid artery puncture and catheter malposition occurred only in the LMG group (2.2%).

Conclusion: Real-time ultrasound guidance significantly improves success rates and reduces complications in IJV catheterization compared to the landmark technique.