Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation

Use of ultrasound guidance for central line placement generally requires two operators: one to hold the transducer and the other to guide the needle. The authors propose a single-operator technique and compare it with the two-operator technique for placement of internal jugular central lines. This was a randomized clinical trial conducted from June to September 2004 in a U.S. urban teaching hospital. Enrollment packets were randomized to dynamic single operator (D1) and dynamic two operator (D2). The procedure was performed under ultrasound visualization in the transverse plane. The primary outcome measure was cannulation success. A complete Bayesian analysis using noninformative priors to estimate the probability of similarity of outcomes for D1 and D2 was performed. All variables are reported with 95% confidence intervals (CIs) where appropriate. Forty-four patients were enrolled from the emergency department and intensive care unit. Twenty-three patients were randomized to D1, and 21 to D2. Cannulation success was 96% (95% CI = 85% to 100%) for D1 and 95% (95% CI = 83% to 100%) for D2. There was a 90% probability that the success rates of these two groups differed by less than 10% of each other. This one-person technique appears to be equivalent to the standard two-person technique for successful ultrasound-guided internal jugular central venous catheterization with respect to overall success.