A Meta-analysis Comparing The Use Of Ultrasound Guidance And The Anatomical Landmark Technique In The Catheterization Of Internal Jugular Vein

Background:Central venous cannulation is a frequently done procedure in clinical practice,for diagnosis,monitoring and treatment purposes in different setups like ICU,operation theatre,emergency department etc.Jugular veins,subclavian veins and femoral veins are the frequently cannulated sites.Internal jugular vein is the one of the most frequently cannulated site.This meta-analysis is done to compare between the ultrasound guided cannulation and anatomical landmark guided cannulation of internal jugular vein and to update in existing evidence based on the findings.Aim:The aim is to evaluate the difference in the effectiveness,safety and complication rates between ultrasound guided(two-dimensional/Doppler)and anatomical landmark guided technique in the catheterization of Internal Jugular vein.Methods:Extensive search for relevant Randomized trials was done in databases like PubMed,ISI Web of Knowledge,EMBASE,and OVID EMB,accompanied by hand search in some related journals and reference lists of relevant articles.Selection of RCTs,data extraction,analysis done based on latest guideline.Inclusion and exclusion criteria were set and used in selection of randomized trials.Results:On the basis of the inclusion criteria,all together thirty randomized trials were included in this meta-analysis with total sample size of 4504.Significant statistical differences were seen between two groups in outcomes like overall success rate RR =1.10,95%CI:1.06-1.14,success in first attempt RR=1.56,95%CI:1.31-1.85,attempts till success RR=-0.65,95%CI:-0.82 to-0.48,access time RR=-1.32 95%CI:-1.86 to-0.77,overall complication rate RR=0.34,95%CI:0.21-0.55,arterial puncture RR=0.23,95%CI:0.14-0.36,hematoma RR=0.22,95%CI:0.13-0.3,cannulation time RR=-189.47,95%CI:-389.38 to 10.44,pneumothorax RR= 0.20,95%CI:0.07 to 0.55,but significant difference were not seen in hemothorax RR = 0.25 95%CI:0.05 to 1.20,brachial plexus irritation RR=0.30,95%CI:0.03 to 2.62.Conclusion:Use of ultrasound guidance increases overall success and success in first attempt,decreases complications like arterial puncture,hematoma,pneumothorax,access time,cannulation time,number of attempts till success and overall complications as compared to anatomical landmark guided cannulation of internal jugular vein.