Comparison of Short Axis Approach with Dynamic Needle Tip Positioning and Oblique Axis Approach for ultrasound guided cannulation Of Internal Jugular Vein in adult patients undergoing elective surgery under general anaesthesia.

The purpose of this study is to compare two ultrasound guided techniques for placing a central line into the internal jugular vein in adults having elective surgery under general anesthesia. It aims to find out which method is more successful on the first attempt, takes less time, needs fewer attempts, and has fewer complications. This study will include patients who need internal jugular vein cannulation. After explaining the procedure, written consent will be obtained from the patient or their relatives. Patients will be randomly divided into two groups using sealed envelopes. Standard monitoring will include ECG, blood pressure, and oxygen levels. General anesthesia will be given using propofol, fentanyl, and vecuronium. After intubation, anesthesia will be maintained with oxygen, nitrous oxide, and sevoflurane. Cannulation will be done on the right internal jugular vein with the patient in a slight head-down position and the head turned to the opposite side. The procedure will be guided by real-time ultrasound using a high-frequency probe. Group I which is Short Axis with Dynamic Needle Tip Positioning, the ultrasound probe will show a cross-sectional view of the vein. The needle will be advanced slowly in small steps while keeping the tip visible on the screen. Once the tip is inside the vein and blood return is seen, a guidewire will be inserted. The needle will be removed, the path will be widened, and a catheter will be placed over the guidewire. Group II which is Oblique Axis Approach,an oblique view of the vein will be used. The needle will be inserted in line with the ultrasound beam, so the entire needle is visible. The needle will be guided into the vein while continuously watching the tip. Once blood return is confirmed, the guidewire, dilator, and catheter will be placed as in the first group. After the procedure, an X-ray or ultrasound will be used to confirm catheter position and rule out complications. Data collected will include patient details, reason for cannulation, success on first attempt, number of attempts, use of ultrasound, time taken, and any complications like artery puncture, hematoma, pneumothorax, misplacement, or infection.