A Comparative study of ultrasound guided central venous cannulation through internal jugular vein in plane, out of plane and lateral oblique approaches- A prospective single blinded randomised controlled trial.

IJV cannulation is one of the most commonly performed procedures in the perioperative period and intensive care unit because of its anatomical position, large diameter in the Trendelenburg position, palpable surface landmarks, and short, straight, valveless course to the SVC and right atrium.

The traditional approach to IJVC is based on anatomical landmarks, but ultrasound-guided central venous catheter placement increases the success rate, reduces the time and number

of attempts of catheter placement and reduces the incidence of mechanical complications such as hematoma, arterial puncture, and hemothorax compared with the traditional landmark technique

The OUT OF PLANE approach will allow simultaneous visualisation of the carotid artery and internal jugular vein, but it will make it difficult to control the needle tip.

The IN-PLANE APPROACH will optimise needle visualisation, but it will be challenging to perform anatomical limitations such as short neck length. The ultrasound image will also display the vein unless the artery lies directly.

There is a high chance of carotid injury underneath the vein.

The LATERAL OBLIQUE approach combines the strengths of both previous approaches. It uses a probe alignment, and the needle is advanced from lateral to medial. This approach optimises the visualisation of the needle and the jugular vein with all its surrounding structures.

The present study aims to assess and compare the performance of the lateral oblique approach with in-plane and out-of-plane approaches, which were previously not compared in terms of cannulation success and the incidence of complications.