Anesthesiologists prefer the internal jugular vein (IJV) for venous cannulation. Most approaches use the sternocleidomastoid muscle as a landmark but, a new approach for internal jugular venipuncture is using bony rather than soft tissue
landmarks
that
was developed by Nobukata et al. In 1991. The landmarks of Nobukata's method consist of four bony landmarks: the notch, which was located just above the medial end of the notch, which was located just above the medial end of the clavicle; the
sternal
end of clavicle; the mastoid process; and the cricoid cartilage.
In order to compare Nobukata's method with Central approach, we evaluated 100 patients prospectively. We allocated randomly two hundreds ASA physical status 1, 2 and 3 patients to two groups. Central approach was employed for central venous
cannulation
in group 1 and Nobukata's method was done in group 2. In both group, two attempts were employed to right IJV and one attempt was done left IJV if right venipuncture was failed or hematoma formation occured.
Successful cannnulation rate on the 2nd attempt was 97% in group 1 and 96% in group 2, and overall success rate was 100% in both groups. Complications included arterial puncture in 3 in 2 cases (2%) in group 2.
From the above results, in some cases of anesthetized patients. Short neck, obese patients whose soft tissue landmarks are less apparent, and during cardic arrest, Nobukata's method can be used alternatively to Central approach.
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