35 International Journal of Scientific Study | May 2014 | Vol 2 | Issue 2 Comparision of Posterior and Anterior Approaches for Internal Jugular Venous Cannulation – A Prospective & Randomised Controlled Study B Vishnu Mahesh Babu 1 , A S Kameswara Rao 2 , B Srikanth 3 1 Associate Professor of Department of Anaesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India, 2 Dean, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India and Formerly Professor and Head of the Department of Anaesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India, 3 Final year Post Graduate, Department of Anaesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India Corresponding Author: Dr. B.Vishnu Mahesh Babu, Rangaraya Medical College/Government General Hospital, Kakinada, Phone: 9848160327, E-mail: bvmaheshbabu@gmail.com  Temporary cardiac pace maker  Hemodialysis  Lack of peripheral venous access Relative contraindications to Central Venous Cannulation  Inexperience, unsupervised operator  Local infection  Distorted local anatomy  Coagulopathy  Previous radiation therapy  Suspected proximal vascular injury Predictors of Difficult Cannulation  Emergency Placement  Obesity  Coagulopathy INTRODUCTION Central venous cannulation is an essential skill for critical care physicians. The choice of Central venous catheter insertion sites will depend on the indications, relative contraindications, risk of complications, patient factors predicting difficult cannulation, and the clinical conditions. The technique for Central venous catheter insertion is the same for single, double, and triple lumen catheters, as well as dialysis lines. Central venous catheterization is a vital intervention in critically ill patients and in major elective & emergency surgeries. Common indications for Central Venous Cannulation  Hemodynamic monitoring  Administration of drugs likely to induce phlebitis Original Article Abstract Introduction: Of the numerous approaches for internal jugular venous cannulation, anterior approach is being widely practiced. But the major complications of this approach are carotid artery puncture and hematoma. With posterior approach, there is lesser incidence of arterial puncture and hematoma. Materials and Methods: This study was conducted over a period of 9 months. The aim of this study is to compare posterior and anterior approaches for internal jugular vein cannulation in terms of number of attempts, duration of cannulation, ease of insertion and complications of approach by each route. 50 patients were considered for the study and they were randomly allocated into two groups to be cannulated with either anterior approach (Group A; n = 25) or posterior approach (Group B; n = 25). Demographic data was comparable in both groups. Results: The number of attempts, duration of cannulation, incidence of arterial puncture, incidence of arterial puncture and hematoma are less with posterior approach. Ease of threading and chance of catheter displacement were comparable among both groups. Conclusion: The posterior approach is better than anterior approach for internal jugular vein cannulation, as it improves the success rate, permits easy threading of catheter, reduces the access time and duration of cannulation. It reduces complications like arterial puncture, hematoma, pneumothorax, catheter displacement and thrombophlebitis. Keywords: Anterior approach, Internal jugular venous cannulation, Posterior approach