Ultrasound-guided internal jugular vein cannulation by Dynamic needle tip positioningusing short axis out of plane approach vs. Long axis in-plane approach for assessing ease and first pass success rate in patients requiring Internal Jugular Vein cannulation : Aprospective randomized study.

Internal jugular vein (IJV) cannulation is a common invasive

procedure in Operation Theatres, ICU, perioperative period and is widely used for

hemodynamic monitoring, infusion of drugs and ionotropes. It was performed by palpatory

method but Ultrasound (USG) guided cannulation has become more popular in recent years

and USG has proven to increase the success rate and decrease the complications.

CVC placement in critically ill patients treated in the ICU, an international expert panel

recommended in 2012 the utilization of 2D US imaging with a long axis/ in plane technique

for vascular access.(2).

However there is a controversy regarding which approach is favourable for the USG probe

i.e. the Dynamic Needle Tip Positioning (DNTP) using short -axis- out of plane approach or

Long-axis- in plane approach. In the Short Axis approach, the relationships of Internal

jugular vein to the adjacent vessels are visualised but the needle tip may not be continuously

visualised during catheter placement. In the Long Axis Approach, the needle tip including the

tip can be continuously visualized, however the relationships to the adjacent vessels may be

lost. For dynamic needle tip positioning, the IJV is approached with Short Axis out of plane

Technique just until the needle tip is displayed as hyperechoic dot on the monitor between the

skin and IJV. While keeping the needle immobile, the probe is parallel shifted away from the

operator just until the cross-sectional image of the needle tip disappears. While keeping the

probe immobile, the needle is advanced until the cross sectional image on the needle tip

reappears on the monitor. The procedure is repeated until the needle tip is inserted profoundly

intravascularly. The position of the needle tip in the centre of the vessel can be controlled

with needle hub steering. This study will be conducted to compare between the Long Axis

and Short Axis techniques (DNTP) in terms of number of skin punctures, number of needle

redirections, time required for insertion of guidewire , success of cannulation and any

complications. .