Ultrasound Guidance vs. Landmark Technique for Catheter Malposition in IJV Catheterization

The Effect of Ultrasound Guidance Versus Landmark Technique on Catheter Malposition in Internal Jugular Vein Catheterization

Central venous catheterization (CVC) via the internal jugular vein (IJV) is a fundamental procedure in anesthesia and intensive care for hemodynamic monitoring, fluid resuscitation, and vasoactive drug administration. While modern clinical guidelines strongly advocate for ultrasound (USG) guidance, the traditional anatomical landmark technique remains widely utilized due to equipment availability or clinician habits. Proper positioning of the catheter tip is critical to prevent severe long-term complications; however, comparative data regarding catheter tip malposition between these two routine techniques-especially when confirmed by postprocedural bedside chest X-ray-require further prospective evaluation. Objective:

The primary objective of this prospective observational study is to compare ultrasound-guided versus landmark techniques for internal jugular vein catheterization with respect to catheter tip malposition, as determined by postprocedural bedside chest X-ray. Secondary objectives include the evaluation of the number of needle redirections, first-attempt success rate, total procedure time, and the incidence of mechanical complications (such as accidental arterial puncture or hematoma formation)

Study Overview

• Status: Not yet recruiting
• Conditions: Central Venous Catheterization; Catheter Malposition
• Intervention / Treatment: Procedure: Ultrasound-Guided Technique; Procedure: Landmark Technique

• Study Type: Observational
• Enrollment (Estimated): 204

Contacts and Locations

• Study Contact: Name: Fikret Salık Assoc. Prof. Dr.; Phone Number: 0507 621 41 25; Email: fikretsalik@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Adult and elderly patients (18-75 years) undergoing elective or scheduled surgery in the general operating room unit of Dicle University Faculty of Medicine Hospital who require central venous catheterization via the internal jugular vein as part of routine perioperative care. The catheterization technique (ultrasound-guided or landmark) reflects the routine practice of the performing physician; no technique is assigned by the study for research purposes.

Description

Inclusion Criteria:

• Patients aged 18-75 undergoing surgery requiring central venous (internal jugular) catheterization

Exclusion Criteria:

• Refusal to participate
• age <18 or >75
• emergency surgery
• coagulopathy
• infection, prior surgery, or prior cannulation at the insertion site
• allergy to ultrasound gel

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Ultrasound-guided group; IJV catheterization performed under real-time ultrasound guidance	Procedure: Ultrasound-Guided Technique; Internal jugular vein catheterization performed with real-time ultrasound visualization of the vein to guide needle insertion.
Landmark technique group; IJV catheterization performed via anatomical landmark technique	Procedure: Landmark Technique; Internal jugular vein catheterization performed using external anatomical landmarks without real-time ultrasound guidance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Incidence of catheter tip malposition	Assessed on postoperative bedside chest X-ray, immediately following the procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Procedural Mechanical Complications	The occurrence and rate of immediate mechanical complications directly related to the intervention, specifically tracking accidental carotid arterial punctures and hematoma formations.	During the procedure and up to 24 hours post-operatively.

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital

Publications and helpful links

General Publications

• Riaz A, Shan Khan RA, Salim F. Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique. J Coll Physicians Surg Pak. 2015 May;25(5):315-9.

Study record dates

Study Major Dates

• Study Start (Estimated): July 15, 2026
• Primary Completion (Estimated): October 15, 2026
• Study Completion (Estimated): October 15, 2026

Study Registration Dates

• First Submitted: July 8, 2026
• First Submitted That Met QC Criteria: July 8, 2026
• First Posted (Actual): July 14, 2026

Study Record Updates

• Last Update Posted (Actual): July 14, 2026
• Last Update Submitted That Met QC Criteria: July 8, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 321/2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No