Anchoring of the internal jugular vein with a pilot needle to facilitate its puncture with a wide bore needle: a randomised, prospective, clinical study

In this prospective, randomised study, consented adult patients of both genders were divided into two groups. In group 1 (n=79) patients, during internal jugular vein cannulation, the pilot needle was removed before the wide bore needle (18G) puncture. In group 2 (n=78) patients, the internal jugular vein was anchored by leaving the pilot needle in place during wide bore needle puncture. In demographically similar groups, the first attempt success rate improved from 64% in group 1 to 81% in group 2 (p<0.05). Internal jugular vein puncture was more frequently detected at the entry of the needle with anchoring (group 2: 78%) than without (group 1: 53%), p<0.05. Ultrasonography of a further 30 internal jugular vein punctures in each group demonstrated that the anchoring manoeuvre (group 2b) significantly (p<0.05) prevented an indenting effect of the puncture needle, with a higher vertical to horizontal diameter ratio of the internal jugular vein when there was anchoring (0.97; SD 0.004) than without pilot needle anchoring (0.65; SD 0.008). In conclusion, when using surface landmarks, anchoring of the internal jugular vein with the pilot needle facilitated its puncture.