Comparative Sonoanatomy of Classic "Short Axis" Probe Position with a Novel "Medial-oblique" Probe Position for Ultrasound-guided Internal Jugular Vein Cannulation: A Crossover Study

J Emerg Med. 2015 May;48(5):590-6. doi: 10.1016/j.jemermed.2014.07.062. Epub 2015 Jan 24.


Background: Ultrasound (US)-guided short-axis approach for internal jugular vein (IJV) cannulation does not fully protect patients from inadvertent carotid artery (CA) puncture. Carotid puncture is not rare (occurring in up to 4% of all IJV cannulations) despite the use of US.

Objectives: Compare the sonoanatomy of the "medial-oblique approach" probe position with the classic US-guided "short-axis" probe position, specifically: relation of internal CA and IJV; vertical and horizontal diameter of IJV; and degree of overlapping of IJV with CA.

Methods: One hundred consecutive patients between the ages of 18 and 50 years, both male and female, and American Society of Anesthesiologists Physical Status classification system (ASA PS) I-II undergoing elective surgery under general anesthesia were recruited in this prospective, randomized, crossover, parallel-group study.

Results: The transverse diameter of the IJV was found to be significantly higher in the medial-oblique probe position (p = 0.000, mean difference 0.43 cm; 95% confidence interval [CI] 0.34-0.52). The percentage of overlap was also significantly lower in the medial-oblique probe position (48.7 ± 10.7% in short-axis vs. 36.3 ± 13.2% in medial-oblique probe position; p = 0.000; mean difference 12.4%, 95% CI 9.1-15.8). However, there was no statistically significant difference in the anteroposterior diameter of the IJV between the two probe positions (1.11 ± 0.26 cm in short axis vs 1.07 ± 0.25 cm in medial oblique; p = 0.631).

Conclusion: The medial-oblique probe position for IJV cannulation provides sonoanatomic superiority over the classic short-axis probe position. Further randomized, controlled trials may confirm the medial-oblique view's clinical benefit in the future.

Keywords: IJV; cannulation; internal jugular vein; ultrasound; ultrasound medial-oblique view; ultrasound short-axis probe view.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Carotid Arteries / anatomy & histology
  • Carotid Arteries / diagnostic imaging*
  • Catheterization, Central Venous / methods*
  • Cross-Over Studies
  • Female
  • Humans
  • Jugular Veins / anatomy & histology
  • Jugular Veins / diagnostic imaging*
  • Male
  • Middle Aged
  • Prospective Studies
  • Punctures
  • Ultrasonography, Interventional / methods*