Comparison of external jugular vein‐based surface landmark approach and ultrasound‐guided approach for internal jugular venous cannulation: A randomised crossover clinical trial

Background and objective Historically, landmark techniques for central venous access through the internal jugular vein (IJV) have yielded a lesser success rate and higher complication rate than the ultrasound (US)‐guided approach. The purpose of this study is to assess the success and safety of a novel external jugular vein (EJV)‐based landmark (EJV‐LM) approach compared with the real‐time US‐guided approach for central venous access through the IJV. Methods This was a prospective, randomised, crossover trial performed in patients during elective cardiac and non‐cardiac surgery. Each resident randomly inserted a central venous catheter using EJV‐LM approach and real‐time US‐guided approach. The primary outcome was first‐attempt success. Secondary outcomes included overall success rate, number of puncture attempts, cannulation time, haematoma and mechanical complications. Results A total of 188 patients were randomly assigned to the EJV‐LM and US groups. The demographic characteristics of the groups were comparable. The first‐attempt success was not different between EJV‐LM and US‐guided techniques (79.8%; [95% CI: 70.2‐87.4] vs 89.4% [95% CI 81.3‐94.8]; P = .06). The overall success rate was 100% with both techniques. There were no differences in the number of puncture attempts with introducer needle (1[1‐3] vs 1[1‐2]; P = .07). Cannulation time was longer in the EJV‐LM group compared with the US group (58.11 ± 6.6 vs 44.27 ± 5.28 seconds; P = .0001). EJV‐LM technique was associated with a higher occurrence of overall complications compared with the US technique (12.8% [95% CI: 6.7‐ 21.2] vs 4.2% [95% CI: 1.1‐10.5]; P = .03). No major mechanical complications were observed with either techniques. Conclusions In patients with non‐distorted neck anatomy and a visible EJV, IJV catheterisation using the EJV‐based LM approach and standard US‐guided technique yielded similar first‐attempt and overall success rates. Cannulation time was longer and complications occurred more frequently in the EJV‐based LM compared with the standard US‐guided technique.