Title: Comparison Of Ultrasound Guided Internal Jugular Vein Cannulation Versus Supraclavicular Approach To Brachiocephalic Vein Cannulation- A Prospective Single Blind Randomised Clinical Study

Background and objectives: Cannulation of veins and arteries is an important aspect of patient care for the administration of fluids, medications and for monitoring purposes. Internal jugular vein (IJV) cannulation is the most commonly studied site for central vein cannulation in adults. The Brachiocephalic vein (BCV) has become a preferred option for central venous cannulation in paediatrics, but its use in adults remains limited and very few studies compare the BCV to other cannulation sites. Recently, a retrospective study was done on USG guided BCV cannulation which suggested that BCV cannulation is a safe and viable alternative to IJV.  The objective of this study is to compare the USG guided out of plane approach to IJV cannulation with in-plane USG guided supraclavicular approach to BCV cannulation in adults for the success rate, first attempt success rate, procedural ease and also to record the incidence of complications related to either approach.

Methodology: In this study, the 110 patients recruited were randomly allocated into two groups of 55 patients each. The patients demographic details like age, gender, indication for cannulation, ventilation status and PEEP applied were noted. In group IJV, right internal jugular vein cannulation was performed using ultrasound guidance out of plane approach and in group BCV, right brachiocephalic vein cannulation was performed using ultrasound guidance for supraclavicular in-plane approach. Success rate of cannulation, number of attempts to cannulate the veins, ease of guidewire and catheter insertion, cannulation time and any associated complications were recorded.

Result: The demographic details were similar between the two groups. Successful cannulation was 100% in BCV group and 98.5% in IJV group, which was statistically insignificant. The first attempt success rate was 81.81% and 76.3% in BCV and IJV group respectively. IJV was collapsed in 14.5% cases and BCV was collapsed in 0.9% cases, which was significant. The needle visualisation was better with BCV group (80% in IJV group and 94.54% in BCV group), which was statistically significant. The number of redirections of needle was more in IJV group. The CVC cannulation time and complication rates were similar between the groups.

Conclusion: Ultrasound guided supraclavicular in-plane BCV cannulation is a good alternative to USG guided out of plane IJV cannulation, by having a good calibre and better needle visualisation in the BCV group. Overall success rate, first attempt success rate, time duration for cannulation and complication rate remain similar between the two groups.