The Comparison of Central Approach and Nobukata`s Method for the Internal Jugular Vein Cannulation

Ahn, Gil Soo; Kang, Sung Hee; Kim, Kyung Han; Jang, Tae Ho; Kim, Se Hwan

Abstract

Anesthesiologists prefer the intemal jugular vein (IJV) for central venous cannulation. Most approaches use the sternocleidomastoid muscle as a landmark but, a new approach for internal jugular venipuncture is using bony rather than soft tissue landmarks that was developed by Nobukata et al. in 1991. The landmarks of Nobukata's method consist of four bony landmarks the notch, which was located just above the medial end of the clavicle; the sternal end of clavicle; the mastoid process; and the cricoid cartilage. In order to compare Nobukata's method with Central approach, we evaluated 100 patients prospectively. We allocated randomly two hundreds ASA physical status 1, 2 and 3 patients to two groups. Central approach was employed for central venous cannulation in group 1 and Nobukata's method was done in group 2. In both group, two attempts were employed to right IJV and one attempt was done left IJV if right venipuncture was failed or hematoma formation occured. Successful cannulation rate on the 2nd attempt was 97% in group 1 and 96% in group 2, and overall success rate was 100% in both groups. Complications included arterial puncture in 3 cases (3%) and in 2 cases (2%) in group 1 and group 2 respectively, and hematoma formation in 2 cases (2%) in group 2. From the above results, in some cases of anesthetized patients, short neck, obese patients whose soft tissue landmarks are less t, and during cardiac arrest, Nobukata's method can be used alternatively to Central approach.