Comparison of ultrasound-guided oblique-axis versus short-axis approaches for right internal jugular vein cannulation in the left decubitus position: a prospective, randomized, single-center trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Central venous cannulation in the left decubitus position is more difficult than in the supine position and may be required when patients cannot safely return to supine. Whether the oblique-axis (OA) approach improves the success and safety of right internal jugular vein (RIJV) cannulation compared with the short-axis (SA) approach remains unknown. METHODS: Seventy-four patients (ASA I-III) scheduled for elective surgery in the left decubitus position under general anesthesia requiring RIJV cannulation were randomly assigned 1:1 to the OA or SA group (n = 37 each). Under real-time ultrasound guidance and a 20° Trendelenburg tilt, cannulation was performed by one of three experienced attending anesthesiologists, each with more than 15 years of experience in ultrasound-guided central venous cannulation. Venipuncture attempts and total procedure time were recorded by a separate investigator; patients were blinded by general anesthesia. The primary outcome was first-time puncture success; secondary outcomes were overall cannulation success, procedure time, venipuncture attempts, and mechanical complications. RESULTS: All 74 randomized patients completed the trial and were analyzed. The first-time puncture success rate was higher in the OA group (27/37 [73.0%] vs. 18/37 [48.6%]; risk difference 24.3%, 95% CI 2.8% to 45.9%; P = 0.032, Pearson chi-square test; Fisher exact test P = 0.056). Venipuncture attempts were fewer in the OA group (median 1 vs. 2; IQR 1-2; P = 0.037). Total procedure time did not differ significantly between groups (median 2.79 [IQR 2.46-3.19] vs. 3.01 [2.72-3.45] min; P = 0.060). Mechanical complications occurred in 6 of 37 patients (16.2%) in the SA group (one arterial puncture and five posterior wall penetrations) and in none in the OA group (P = 0.025); overall cannulation success was 100% in both groups. CONCLUSIONS: For RIJV cannulation in the left decubitus position, the oblique-axis approach was associated with a higher first-time puncture success rate than the short-axis approach and with fewer mechanical complications detected during or immediately after the procedure; however, the primary-endpoint evidence was borderline and the complication estimates were imprecise. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400091385; registered 28 October 2024).
Source: BMC Anesthesiology
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
OpenAlex ID: W7222952363