Comparison of the needle tip location with the operator's position during ultrasound-guided internal jugular vein catheterization: A randomized controlled study

Abstract

Objective: We hypothesized that when a right-handed operator catheterizes the left internal jugular vein (IJV), the tip of the needle might be positioned closer to the center of the vessel after puncture if the operator is standing in the patient's left axillary line, rather than standing cephalad to the patient.

Methods: The study randomly allocated 44 patients undergoing elective surgery under general anesthesia with planned left central venous catheterization to either conventional (operator stood cephalad to the patient) or intervention (operator stood in the patient's axillary line) groups. The left IJV was catheterized by 18 anesthesiologists. The distance between the center of the vessel and the needle tip, first-attempt success rate, and procedure time were compared.

Results: The distance from the needle tip to the center of the IJV after needle puncture was 3.5 (1.9-5.5) and 3.2 (1.7-4.9) cm in the conventional and intervention groups, respectively (P = .47). The first-attempt success rate was significantly higher in the intervention group (100% vs 68.2%, P = .01). Overall time to successful guidewire insertion was faster in the intervention group (P = .007).

Conclusions: There was no significant difference in needle tip position when the right-handed operator was standing in the patient's left axillary line compared to standing cephalad to the patient during left IJV catheterization. However, it increased the first-attempt success rate and reduced the overall time for guidewire insertion.

Trial registration: ClinicalTrials.gov NCT03936543.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.

Consort diagram representing patient enrollment.

Figure 2.

Operator position during central venous catheterization. In the conventional group, the operators stood cephalad to the patient. In the intervention group, the operators moved one step to the left from the middle and stood at the patient’s axillary line.

Figure 3.

Distance from center of vessel to needle tip after vascular puncture. Boxes indicate the interquartile range, the bold line in the box are the median values, and the whiskers indicate minimum and maximum values that are not outliers.

Figure 4.

Kaplan–Meier plot demonstrating proportion of subjects with failed guidewire insertion to the internal jugular vein relative to time according to groups. The median (Interquartile range) time (sec) to successful guidewire insertion was 56.5 (20.0–114.0) in the conventional group compared with 39.0 (28.0–50.0) in the intervention group. Data were analyzed using the log-rank test.