Ultrasound-guided central venous cannulation: is there a difference between Doppler and B-mode ultrasound?

Study ObjectiveTo compare the success of Doppler and B-mode ultrasound–guided internal jugular vein (IJV) catheterization with respect to body mass index (BMI).Study DesignProspective, randomized study.SettingSection for cardiovascular anesthesia of a university hospital.Patients338 consenting patients were analyzed.InterventionsSubjects receiving central venous catheters for scheduled cardiac surgery were divided into two groups. After induction of general anesthesia, the right or left IJV was assessed for midcervical cannulation approach. In the Doppler group (n = 189), a SonoGuide2 with a 5.0-MHz probe was used. In the B-mode group (n = 149), the SiteRite II ultrasound system with a 7.5-MHz transducer was used.Measurements and Main ResultsThere was a significant difference in the success rate of first needle pass between the two groups: Doppler group, 91% (172/189); B-mode group, 96.6% (144/149) (P = 0.045). A BMI of 30 and greater was associated with a significantly lower first needle pass success rate in the Doppler group (Doppler group, 77.1% [27/35]; B-mode group, 97.4% [38/39]; P = 0.011). The success rates in patients with a BMI below 30 for both methods were not different (Doppler group, 94.2% [145/154]; B-mode group, 96.4% [106/110]; P = 0.567). Arterial punctures occurred three times under Doppler guidance and twice under B-mode guidance.ConclusionCannulation of the IJV can be ensured and first needle pass success rate maximized by both ultrasound techniques. In patients with a BMI greater than 30, B-mode technique is superior to Doppler ultrasound.