Facilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device

Abstract

Objective To determine the utility of an audio-guided Doppler ultrasound device in improving success and decreasing complications in cannulation of the internal jugular vein in high-risk patients. Design Prospective, randomized, crossover clinical study. Setting Two major university medical centers in critical care environments. Patients Seventy-six consecutive, consenting adult patients with preexisting obesity or coagulopathy requiring central venous access. Interventions Subjects enrolled in the study were randomized to receive either the traditional ``blind'' (control) technique or the ultrasonic technique. A maximum of three cannulation attempts were allowed before crossover to three attempts with the alternative technique. All cannulations were attempted via the internal jugular vein through a high/central approach. Results Patient and operator characteristics were similar between groups. The initial use of an audio-guided ultrasound device was associated with increased success of cannulation (84.4% vs. 61.4%; p less than .05) and decreased need to crossover to the alternative technique. Success on the first needle pass was more likely with the ultrasound technique (56.3% vs. 29.5%; p less than .05). Significant complications were greater with the control technique (carotid artery puncture 16.3% vs. 2.0% [p less than .02]; any significant complication 26.5% vs. 6.1% [p less than .01]). Conclusions The use of an audio-guided Doppler ultrasound vascular access device was associated with increased success of cannulation and a decreased frequency of significant complications in a population of high-risk patients with obesity or coagulopathy. (Crit Care Med 1995; 23:60-65)