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.
- 1Department of Anesthesiology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China. [email protected].
- 2Department of Anesthesiology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
- 3Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA.
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).
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BibTeX
@article{liu2026comparison,
title = {{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.}},
author = {Wenjuan Liu and Zhe Su and Junfeng Zhang and Mingjiang Yi and Ling Han and Jingwei Zhou},
journal = {BMC anesthesiology},
year = {2026},
month = oct,
doi = {10.1186/s12871-026-04360-3},
url = {https://europepmc.org/article/MED/42972228},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Wenjuan Liu
AU - Zhe Su
AU - Junfeng Zhang
AU - Mingjiang Yi
AU - Ling Han
AU - Jingwei Zhou
PY - 2026
DA - 2026/10/19
JO - BMC anesthesiology
DO - 10.1186/s12871-026-04360-3
UR - https://europepmc.org/article/MED/42972228
AB - 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).
SN - 1471-2253
ER -