Comparison of short and long axis ultrasound-guided approaches to internal jugular vein puncture: a meta-analysis

OBJECTIVE: To compare short-axis versus long-axis plane for ultrasound-guided internal jugular vein puncture. METHODS: PubMed, Embase, Cochrane Library and CNKI databases were searched for randomized controlled trials, published to 1 June 2019, that compared short- versus long-axis plane in ultrasound-guided internal jugular vein puncture. Statistical analyses were performed using RevMan software, version 5.3. Statistical results are presented as risk ratio (RR) (95% confidence interval [CI]) for dichotomous data and standard mean difference (SMD) (95% CI) for continuous data. RESULTS: Ten studies fulfilled the inclusion criteria. Analyses of pooled results showed no statistically significant differences in arterial puncture incidence between the two planes (RR 0.73 [95% CI 0.38, 1.39]). First-pass success rate (RR 1.08 [95% CI 0.95, 1.22]), total success rate (RR 1.00 [95% CI 0.99, 1.02]) and number of attempts required (SMD –0.09 [95% CI –0.37, 0.18]) were also similar between the two approaches. Trial sequential analysis indicated that the available evidence was insufficient to detect potential differences between the two techniques. CONCLUSIONS: There is insufficient data for an evidence-based choice of either short- or long-axis plane in ultrasound-guided internal jugular vein puncture.