BACKGROUND: The cannulation of the internal jugular vein (IJV) is a frequent procedure in critically ill patients. According to the guidelines, real-time ultrasound navigation is recommended. Traditional techniques pose several disadvantages, such as suboptimal needle visualization. Therefore, this non-inferiority trial aimed to describe the novel approach and compare the novel lateral in-plane short-axis approach for IJV access with the conventional short-axis out-of-plane approach. OBJECTIVES: The primary objective of the trial was to prove that the first attempt success rate in the novel technique is non-inferior to the conventional technique. The secondary objectives were to demonstrate that the complication rate and the functional duration of the catheter in the novel technique are not inferior to those in the conventional technique. METHODS: Patients eligible for IJV cannulation were randomly assigned to either the novel technique (Group A) or the conventional one (Group B). The procedure duration, success rate and the number of attempts required were documented. The functionality of the catheter and complications were monitored from insertion until the catheter removal. Standard descriptive statistical methods were employed for the analysis. RESULTS: A total of 200 subjects were equally divided between Group A and Group B. For the primary outcome, there was no significant difference in first attempt success rate (Group A: 79, Group B: 77, p = 0.434). Secondary outcomes, including complications and catheter functional time, did not differ significantly between the groups. However, the novel technique demonstrated a significantly faster procedure time (Group A: 315 s, Group B: 330 s, p = 0.016). Notably, the novel approach was linked with significantly larger IJV diameter measured during the procedure (Group A: 18.2 mm, Group B: 12.1 mm, p < 0.001). CONCLUSION: The novel lateral in-plane short-axis approach for IJV cannulation is a non-inferior alternative with a lower incidence of posterior vessel wall puncture compared to the conventional approach.

Department of Anaesthesia and Intensive Care Medicine 3rd Faculty of Medicine Prague Charles University Ruska 97 Prague 100 00 Czech Republic

Department of Anaesthesia Pain Management and Perioperative Medicine Dalhousie University Halifax NS B3H 4R2 Canada

Department of Anaesthesiology and Resuscitation Care Decin Hospital U Nemocnice 1 Decin 405 02 Czech Republic

Department of Anaesthesiology Perioperative and Intensive Care Nemocnica Bory a S Ivana Kadlecika 2 Bratislava 841 03 Slovak Republic

Department of Anaesthesiology Perioperative Medicine and Intensive Care Masaryk Hospital in Usti Nad Labem J E Purkinje University Socialni Pece 3316 12A 401 13 Usti Nad Labem Czech Republic

Department of Anaesthesiology University Hospital Bulovka Budinova 2 Prague 180 00 Czech Republic

Department of Anesthesiology and Intensive Care Medicine University Hospital Hradec Kralove Sokolská 581 Hradec Kralove 500 05 Czech Republic

Department of Neurosurgery 2nd Medical Faculty Charles University and Motol University Hospital 5 Uvalu 84 Prague 150 06 Czech Republic

Emergency Medicine Department Nemocnica Bory a S Bratislava Slovak Republic

Faculty of Health Studies Technical University in Liberec Studentska 1402 Liberec 460 01 Czech Republic

Faculty of Medicine in Hradec Kralove Charles University Simkova 870 Hradec Kralove 500 03 Czech Republic

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