Comparative evaluation between external jugular and internal jugular venous catheterization through landmark technique.

BACKGROUND: Cannulation of a central vein is crucial in patients for hemodynamic management and when insertion of a peripheral line is not possible. The internal jugular vein is the preferred access site; however, in the case of not being accessible, the second cannulation site of choice is still unclear. The study aimed to access the feasibility of external jugular vein cannulation versus internal jugular vein cannulation in terms of success, cannulation time, number of attempts and complications. MATERIALS AND METHODS: In this prospective, randomised double-blinded study, 100 patients received 7Fr size triple-lumen central vein catheter either in the internal jugular vein (n = 50) or external jugular vein (n = 50) through the landmark technique as a part of anaesthetic care in the operation theatre. The number of attempts, cannulation time and incidence of complications in both the techniques were observed and recorded. RESULTS: The success rate in internal jugular vein cannulation was 88%, while in the external jugular vein, it was 78% (p = 0.17). The external jugular vein cannulation was comparatively quicker in our study (p = 0.01). Similarly, elevated body mass index did not affect the success rate in the number of cannulations attempts in either group (p = 0.08). In terms of complications, the internal jugular vein group had a total of 20% and the external jugular vein group had 28% complications; however, the complications were more severe in the internal jugular vein group. CONCLUSION: Anaesthetists should rethink alternate routes for the insertion of central vein cannulation. The external jugular cannulation route is one of them.

Compare the efficacy of recommended peripheral intravascular cannula insertion practices with a standard protocol: A randomized control trial.

Background: Millions of patients admitted globally in health care setups require insertion of peripheral intravascular catheter for intravenous drugs or fluid administration. However, if proper precautions are not followed during insertion, it results in significant morbidity. This study was designed to study the efficacy and safety of recommended Centre for Disease Control and Prevention (CDC) guidelines for peripheral intravascular catheter insertion practice and its comparison with a standard insertion protocol being followed and their outcome. Methods: Patients were randomized and catheter was inserted as recommended by CDC guideline (Group 1, n = 100) or followed standard defined steps during insertion (Group 2, n = 100). Results: Almost double the patients had occurrence of thrombophlebitis in Group 1 (p = 0.02). No difference observed between catheter needle size and infection rates (p = 0.3). Infection rate increased significantly if second attempt is taken for insertion. The time required to insert catheter following CDC recommended protocol is less than as by standard surgical complete asepsis cleaning protocol (86.03 vs 109.40 s) (p = 0.001). Study also observed that insertion at wrist joint leads to higher incidence of thrombophlebitis. During 0-24 h, 6% (12) insertions turned positive followed by a dip during 25-48 h, 2% (5) insertions. 80% (159) insertions did not develop thrombophlebitis at the end of 72 h. Conclusion: It is thus amply demonstrated that meticulous adherence to insertion procedure with asepsis plays an important role in decreasing intravascular catheter associated morbidity. Other parameters like needle gauge, sites of insertion, have little bearing. The time required in following standard aseptic technique is significantly more but keeping in view the benefit to the patient it is highly recommended.