Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients a prospective observational pilot study.

Aim: This study aims to evaluate the safety of ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients. Methods: Adult subjects admitted in the intensive care unit, undergoing emergency cannulation of internal jugular vein under real time ultrasonographic guidance with platelet count less than 50,000/cu mm and/or international normalized ratio (INR) more than 1.5 were enrolled. Major and minor complications during the procedure were noted. Results: Internal jugular vein was successfully cannulated in all the patients. The mean INR of patients having minor complications (provided that platelet count u003e 50000) was found to be 3.07 with 95% confidence interval(CI) being 2.37-3.77. The mean platelet count of patients having minor complications (provided that the INR 7mm vs 7mm or less; p value 0.027). Number of attempts while performing internal jugular vein cannulation was associated with minor complications (mean 1.5 with CI 1.2-1.78 vs mean 1.08 with 95% CI 1.00-1.25; p value 0.023). No major complications were reported during the study regardless of platelet count, INR, margin of safety or number of attempts. Conclusions: Emergency cannulation of internal jugular vein may be safely performed in coagulopathic adult patients under real-time ultrasound guidance when performed by an experienced physician. Bangladesh Crit Care J September 2017; 5(2): 93-96