Comparisona Of Sono Anatomy Of Medial Oblique Axis View And Short Axis View In Ultrasound Guided Central Venous Catheter Placement Of Right Internal Jugular Vein- A Randomised Controlled Study

Abstract

Introduction: This randomized controlled trial compared two ultrasound probe positions, the short axis and the medial oblique axis, for internal jugular vein (IJV) catheterization. The study evaluated the sono anatomy of the IJV relative to the carotid artery (CA), as well as the safety of each technique by measuring first-pass success rate, number of needle attempts, and complications.

Methods: Patients undergoing ultrasound-guided IJV catheterization were randomized into two groups. Measurements of the IJV's transverse diameter and the CA's position (medial, postero-medial, or posterior) were taken using both the short axis and medial oblique views. First-pass success rate and the number of needle attempts were recorded for each technique. Statistical analysis was performed to compare the two methods.

Results:  The medial oblique axis view yielded a significantly larger mean transverse diameter for the IJV (2.08±0.092 cm) compared to the short axis view (1.69±0.13 cm; p<0.005). The medial oblique view also showed a higher prevalence of the CA in the postero-medial position. The first-pass success rate was significantly greater in the medial oblique group (86.7%) compared to the short axis group (p=0.001), and the number of needle attempts was substantially lower (1.13±0.34 vs. 1.7±0.79; p=0.001).

Conclusion: The medial oblique axis view is superior to the short axis view for ultrasound-guided IJV catheterization. This technique provides a better anatomical view, leading to a greater first-pass success rate and fewer needle attempts. These findings support the medial oblique view as the optimal method for central venous catheterization, reducing the risk of complications such as unintentional carotid artery puncture.