Comparison of Success of Long-axis versus Short-axis Ultrasound-guided Right Internal Jugular Vein Cannulation in Adult Intensive Care Unit Patients: A Prospective Comparative Observational Study

BACKGROUND: Ultrasound-guided internal jugular vein (IJV) cannulation is recommended to improve the success and safety of central venous catheterization. Both long-axis and short-axis ultrasound approaches are widely practiced; however, evidence regarding their comparative performance remains inconclusive. OBJECTIVE: To compare the success and safety of long-axis and short-axis ultrasound-guided right IJV cannulation in adult intensive care unit patients. MATERIALS AND METHODS: This prospective comparative observational study was conducted in the Department of Anaesthesiology and Critical Care Medicine, JSS Medical College and Hospital, Mysuru, over 18 months. A total of 106 adult patients requiring right IJV cannulation were enrolled and allocated into the long-axis group (n = 53) and the short-axis group (n = 53). The primary outcome was first-pass cannulation success. Secondary outcomes included needle redirections, skin punctures, guidewire and catheter insertion times, hemodynamic changes, electrocardiographic findings, and procedure-related complications. RESULTS: Baseline characteristics were comparable between the groups. First-pass success was achieved in 90.6% of the long-axis group and 96.2% of the short-axis group (P = 0.240). Needle redirection was significantly less frequent with the short-axis approach (15.1% vs. 32.1%; P = 0.039). The number of skin punctures, guidewire insertion time, catheter insertion time, total procedural time, and overall complication rates were comparable. No carotid artery puncture, pneumothorax, hemothorax, or catheter malposition occurred in either group. CONCLUSION: Both long-axis and short-axis ultrasound-guided techniques provide high success rates and excellent safety for right IJV cannulation. Although the short-axis approach required fewer needle redirections, both techniques demonstrated comparable procedural efficiency and complication rates. The choice of approach should therefore be guided by operator experience and patient anatomy.