A 45° set Square Method for Accurate Needle Insertion in Ultrasound-guided Internal Jugular Venous Catheterization

Abstract

Purpose: Until now, there has been no standardized method for insertion of the introducer needle in ultrasoundguided internal jugular venous catheterization (IJVC). The needle insertion site and angle have been determined by the performer`s experiences. In an effort to improve first attempt success rates and reduce complications, we designed a new standardized approach (called the 45°set square method) for determination of the site and angle of needle insertion during ultrasound-guided IJVC. This study investigated that the clinical usefulness of the novel 45°set square method for ultrasound-guided IJVC in the emergency department. Methods: We conducted a prospective study in the emergency department (ED) of a tertiary teaching hospital. Forty one patients requiring central venous catheterization were enrolled in the study. They were randomized to either the conventional ultrasound guidance group or the 45°set square group. The primary outcome measure was success rate within three attempts and secondary measures were the number of trials, first-attempt success, puncture time, complications, and technical difficulty score. Results: All 41 participants completed this study successfully. Twenty one consecutive patients were enrolled in the 45°set square group and 20 were enrolled in the conventional group. The 45°set square group (100%) was superior to the conventional group (60%) in overall success rate within three attempts (p=0.001) and the number of attempts (p<0.001). Significant differences in puncture time (p=0.004), hematoma (p=0.048), and technical difficulty score (p<0.001) were observed between the groups. Conclusion: The 45°set square method is an effective and safe method for ultrasound-guided internal jugular venous catheterization.