COMPARATIVE EVALUATION OF REAL-TIME ULTRASONOGRAPHY GUIDED VERSUS CONVENTIONAL ANATOMICAL LANDMARK GUIDED TECHNIQUE FOR CENTRAL VENOUS CANNULATION IN ELECTIVE CARDIAC SURGERY PATIENTS

Authors

  • Dr. Onzima Suba Specialist Grade II, Chittaranjan National Cancer Institute, kolkata Author
  • Dr. Ujjwal Mondal Senior Consultant, Dept. of Anaesthesiology, Zenith Super Specialist Hospital, Kolkata Author
  • Dr. Kuntal Bhaumik Professor, Institute of Child health, Kolkata Author
  • Dr Sumanta Kumar Senior Consultant, Dept. of Anaesthesiology, Zenith Super Specialist Hospital, Kolkata Author
  • Dr. Anirban Kumar Ghosh Senior Consultant, Dept. of Anaesthesiology, Zenith Super Specialist Hospital, Kolkata Author

DOI:

https://doi.org/10.61841/x66m6g19

Keywords:

Ultrasound-guided cannulation, Central venous catheterization, Internal jugular vein, Landmark technique , Cardiac surgery patients

Abstract

Central venous catheterization is a critical procedure in cardiac and intensive care practice, with both conventional anatomical landmark technique and real-time ultrasonography guidance being used for internal jugular venous cannulation. This prospective randomized study compared the efficacy, safety, and procedural characteristics of ultrasound-guided cannulation with the landmark technique in 76 adult patients undergoing elective cardiac surgery. All procedures were performed by an experienced anesthesiologist, and outcomes included number of attempts, access time, total cannulation time, overall success rate, and procedure-related complications. The ultrasound group demonstrated significantly shorter access time (39 vs 118 seconds, p = 0.001) and total cannulation time (225.84 vs 438.95 seconds, p < 0.001). Although overall success rates were comparable (76.32% vs 78.95%, p = 1.00), complications such as carotid artery puncture and hematoma occurred only in the landmark group. No cases of pneumothorax, hemothorax, or catheter malposition were observed in either group. The findings indicate that ultrasound guidance facilitates faster venous access with fewer complications, supporting its routine use in central venous cannulation, particularly in cardiac surgical patients.

References

Webb AR, Shapiro MJ, Singer M. Oxford Textbook of Critical Care. Oxford: Oxford University Press; 1990.

Benumof JL. Clinical Procedures in Anesthesia and Intensive Care. Philadelphia: J.B. Lippincott Company; 1992.

Amar D, Melendez JA, Zhang H, et al. Correlation of peripheral venous pressure and central venous pressure in surgical patients. J Cardiothorac Vasc Anesth. 2001;15:40-43.

Kirby RR. Critical Care. 2nd ed. Philadelphia: J.B. Lippincott Company; 1992.

Desjardins M, Sulpher J, Lee BC. Can peripheral venous pressure be interchangeable with central venous pressure in patients undergoing cardiac surgery? Intensive Care Med. 2004;30(4):627-632.

Anter AM, Bondok RS. Peripheral venous pressure as an alternative to central venous pressure in paediatric surgical patients. Acta Anaesthesiol Scand. 2004;48(9):1101-1104.

Jernigan WR, Gardener WC, Mahr MM, Miliburn JL. Use of the internal jugular vein for placement of central venous catheter. JAMA. 1971;218(1):97-98.

Daily PO, Griep RB, Shumway NE. Percutaneous internal jugular vein cannulation. Arch Surg. 1970;101:1103-1108.

Munis JR, Bhatia S, Lozada LJ. Peripheral venous pressure as a hemodynamic variable in neurosurgery patients. Anesth Analg. 2001;92:172-179.

Tugrul M, Camei E, Pemberi K, Al-Darsani A, Telei U. Relationship between peripheral and central venous pressure in different patient positions, catheter sizes and insertion sites. J Cardiothorac Vasc Anesth. 2004;18(4):446-450.

Walsh JT, Heldick DJR, Smith SA, Nawell SA, Lowe MD, Duwarakan KS, et al. Comparison of central venous and inferior vena caval pressures. Am J Cardiol. 2000;85:518-520.

Mallory DL, Shawker TH, Evans RG, et al. Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation. Crit Care Med. 1990;18:1269-1273.

Wilson JN, Grow JB, Demong CV, et al. Central venous pressure in optimal blood volume maintenance. Arch Surg. 1982;85:563-568.

Hermosura B, Vanags L, Dickey NW. Measurement of pressure during intravenous therapy. JAMA. 1966;195:321-324.

Craig RG, Jones RA, Sprout J, et al. Alternative methods of central venous system catheterization. Am J Surg. 1968;34:131-134.

Dhawan B, Gadepalli R, Kapil A. Infective complications of central venous catheters in cardiac surgical patients. Indian J Pathol Microbiol. 2001;44(2):124-129.

Richet H, Hubert B, Nitemberg G, Andremont A, Beuu-Hoi, Ourbak P, et al. Prospective multicenter study of vascular catheter-related complications and risk factors for positive central catheter cultures. J Clin Microbiol. 1990;28(11):2520-2525.

Bradley RD, Mendel D. A Practice of Cardiac Catheterization. Oxford: Blackwell Scientific Publications; 1968.

Schapira M, Stern WZ. Hazards of subclavian vein cannulation for central venous pressure monitoring. JAMA. 1967;201:327-329.

English IC, Frew RM, Pigott JF. Percutaneous catheterization of the internal jugular vein. Anaesthesia. 1969;24:521-531.

Lieberman JA, Williams KA, Rosenberg AL. Optimal head rotation for internal jugular vein cannulation using external landmarks. Anesth Analg. 2004;99(4):982-988.

Rao TLK, Wong AY, Salem MR. A new approach to percutaneous catheterization of the internal jugular vein. Anesthesiology. 1977;46:362-364.

Hayashi H, Ootaki C, Tsuzuku M, Amano M. Respiratory jugular vasodilation: a new landmark for right internal jugular vein puncture in ventilated patients. J Cardiothorac Vasc Anesth. 2000;14:40-44.

Mitchell SE, Clark RA. Complications of central venous catheterization. Am J Roentgenol. 1979;133:467-476.

Digby S. Fatal respiratory obstruction following insertion of a central venous line. Anaesthesia. 1994;49:1013-1014.

Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization: failure and complication rates by three percutaneous approaches. Arch Intern Med. 1986;146:259-261.

Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators: a prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33:1055-1059.

Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. J Clin Anesth. 2011;23(6):415-426.

Miller A, Bhatia P, Kendall J. Ultrasound guidance for central venous cannulation. Emerg Med J. 2000;17:160-163.

Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis. Crit Care Med. 1996;24:2053-2058.

Rothschild JM. Ultrasound guidance of central venous catheterization. Evidence Report/Technology Assessment No. 43. AHRQ; 2001:245-253.

Palepu GB, Juneja D, Subrahmanyam M, Mohan S. Impact of ultrasonography on central venous catheter insertion in intensive care. Indian J Radiol Imaging. 2009;19(3):191-198.

Grabenik CR, Boyce A, Sinclaire ME, Evans RD, Mason DG, Martin B. Guidance on the use of ultrasound locating devices for placing central venous catheters. London: National Institute of Clinical Excellence; 2002.

Fry WR, Clagett GC, O’Rourke PT. Ultrasound-guided central venous access. Arch Surg. 1999;134(7):738-741.

Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. Real-time ultrasound-guided catheterization of the internal jugular vein: prospective comparison with landmark technique in critical care patients. J Crit Care. 2006;10(6):843-863.

Fragou M, Gravvanis A, Dimitriou V, et al. Real-time ultrasound-guided subclavian vein cannulation versus landmark method in critical care patients: a prospective randomized study. Crit Care Med. 2011;39:1607-1612.

Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis. Crit Care Med. 1996;24:2053-2058.

Palepu GB, Juneja D, Subrahmanyam M, Mohan S. Impact of ultrasonography on central venous catheter insertion in intensive care. Indian J Radiol Imaging. 2009;19(3):191-198.

Agarwal A, Singh DK, Jain A. Comparison of ultrasound-guided versus landmark technique for internal jugular venous cannulation in Indian ICU. J Anaesthesiol Clin Pharmacol. 2010;26(4):501-504.

Grabenik CR, Boyce A, Sinclaire ME, Evans RD, Mason DG, Martin B. Guidance on ultrasound locating devices for placing central venous catheters. NICE; 2002.

Vezzani A, Manca T, Brusasco C, et al. Ultrasound localization for safe central venous cannulation: a review. Minerva Anestesiol. 2010;76:529-536.

Fry WR, Clagett GC, O’Rourke PT, Sinclaire ME. Improved outcomes with ultrasound-guided venous cannulation in Indian intensive care: a multicentre experience. Indian J Crit Care Med. 2011;15(2):98-105

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Published

2026-02-05

How to Cite

Suba, O. ., Mondal, U. ., Bhaumik, K. ., Kumar, S. ., & Ghosh, A. K. . (2026). COMPARATIVE EVALUATION OF REAL-TIME ULTRASONOGRAPHY GUIDED VERSUS CONVENTIONAL ANATOMICAL LANDMARK GUIDED TECHNIQUE FOR CENTRAL VENOUS CANNULATION IN ELECTIVE CARDIAC SURGERY PATIENTS. Journal of Advanced Research in Medical and Health Science (ISSN 2208-2425), 12(1), 8-15. https://doi.org/10.61841/x66m6g19

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