Comparison of a novel real-time needle guidance ultrasound technique with conventional ultrasound for central venous line (internal jugular vein) access among patients in intensive care unit of UNIVERSITY MALAYA MEDICAL CENTRE

INTERVENTION: The procedure is to cannulate internal jugular vein either with the technique of novel real time needle guidance or conventional ultrasound method. Novel real time needle guidance is based on an electromagnetic field that communicates with a transducer and an electromagnetic sensor sheathed by a vascular access needle. Needle movements and related magnetic field variation allow navigation system to compute the location of the transducer and needle. And when the probe and needle which is sheathed with the electromagnetic sensor are placed onto the patient, the target box and trajectory pathway will appear on the screen. Hence with this navigation system, the operator will be able to advance the needle into the target box (cross sectional of vein). In contrary to this, the conventional ultrasound technique is devoid of the navigation system. The medical officer will complete the procedure, at they will be at least one year of experience in anaesthesia. The procedure will take about 20 to 30 seconds CONDITION: Critically ill patients PRIMARY OUTCOME: Performance time between conventional ultrasouncd and novel real time needle guidance ultrasound by using a stopwatch. to compare cumulative cannulation success by method, allow up to 5 attempts, but if it is unsuccessful, then a senior anesthetist will be required to perform the task.. SECONDARY OUTCOME: Any complications that arise from the procedure such as secondary tissue injury, hematoma, bleeding, pneumothorax or hemothorax will be documented ; ; to assess satisfaction of operator towards the methods by using satisfaction 10 point scale, 1 as extremely dissatisfied while 10 as extremely satisfied. INCLUSION CRITERIA: All the patients who require central venous line insertion