Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients

BACKGROUND: Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients for whom it is difficult to establish peripheral IV access. We aimed to investigate the feasibility and safety of EJV cannulation in surgical patients. METHODS: We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collected clinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included any EJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis, pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronic medical records during the hospitalization period for surgery. RESULTS: We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery (49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%). Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases. The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site (65 cases, 0.7%). There was only one case of unplanned intensive care unit admission due to swelling related to EJV cannulation. CONCLUSIONS: Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.