Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients.
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Date
2016-10
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Abstract
Background: The primary aim of this study was to compare the incidence of accidental arterial puncture
during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The
secondary end points were to assess if USG improves the chances of successful first pass cannulation
and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made
for successful cannulation. Settings and Design: Prospective observational study performed at a single
tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical
patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation
and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical
analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was
used for qualitative variables. Results: The overall incidence of accidental arterial puncture in the entire
study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup
analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients
(P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG
(P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients.
Conclusions: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and
simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult
cardiac surgical patients.
Description
Keywords
Blood vessels/injuries, Blood vessels/ultrasonography, Catheterization, Central venous/adverse effects
Citation
Maddali Madan Mohan, Venkitaramanan Arun, Al-Ajmi Ahmed Wala, Al-Bahrani Maher Jaffer, Cheskey Manoj Jayatilaka, Arora Ram Nishant. Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients. Annals of Cardiac Anaesthesia. 2016 Oct; 19(4): 594-598.