ABSTRACT
Central venous cannulation is a vital intervention in the critically ill and in
patients undergoing elective and emergency surgeries. Success depends on proper
choice of insertion site. Internal jugular vein has a valveless course to superior
vene cava, possibility of repeated cannulation and low incidence of complications.
Knowledge of various approaches for Internal jugular vein cannulation is
imperative.
AIM OF THE STUDY
The aim of the study is Comparison of the Anterior and
Posterior approaches for internal jugular vein cannulation, in terms of
1. No. of attempts,
2. Duration of cannulation,
3. Ease of insertion and,
4. Complications of each route.
MATERIALS AND METHODS:
It was a prospective randomised study. 60 patients of similar age group,
weight and equal sex distribution were randomly classified into two groups. IJV
cannulation was done by anterior approach in Group A and by posterior approach
in Group P. The following parameters were compared - number of attempts, time
for identification of vein, duration for cannulation, ease of threading, carotid
puncture, haematoma, pneumothorax, hemothorax , catheter kinking, catheter
displacement, thrombophlebitis and limitation of neck movements. A similar
analysis was made in the pbose patients.
STATISTICAL ANALYSIS:
A sample size of 30 per group was decided during the pilot study.Randomisation
of subjects to the two groups was done by using sealed envelopes.
Data was expressed as mean ± SD. Quantitative analysis was compared with
independent sample student’s t-test.Qualitative analysis was compared with chi-square
test.When using these tests to compare mean among two groups,p-value of less than
0.05 was taken as significant.All analyses were done using SPSS version 11.5
statistical software.All values were rounded off to a maximum of two decimals.
RESULTS:
All the patients were comparable in terms of age, gender and body mass
index. The number of attempts, time for identifying the vein and duration of
cannulation was lessere in the posterior approach. The rate of carotid puncture,
haematoma, pneumothorax, catheter kinking, displacement, thrombophlebitis and
limitation of neck movements was less with the posterior approach.
CONCLUSION:
In conclusion, the posterior approach is better than the anterior approach for
Internal jugular vein cannulation as it improves the success rate, permits easy
threading of catheter, reduces the access time and duration of cannulation.It reduces
the complications like carotid puncture, haematoma, pneumothorax, catheter
kinking, catheter displacement,thrombophlebitis and limitation of neck
movements.It permits easier access,improves the success rate and reduces the
complications in obese patients
