Background: National guidelines advocating ultrasound-guidance of internal jugular venous cannulation were introduced in the United Kingdom in 2002, followed by international guidelines a decade later. However the benefits of ultrasound-guidance do not appear to have universally translated into clinical practice. This study therefore aimed to investigate the effect of ultrasound on the practice of internal jugular vein cannulation.
Methods: We conducted an ethnographic study incorporating observations, interviews and focus groups in two hospitals in the North of England over a four-month period.
Results: Twenty-seven clinical observations, ten interviews and three focus groups were conducted. In 25 clinical episodes ultrasound-guidance was used. Four distinct needling techniques were observed which we have classified in terms of needle angulation as the traditional landmark technique, the ultrasound-guided traditional approach, ultrasound-guided medial angulation, and the ultrasound-guided steep approach. The latter two techniques represent a departure from conventional practice and appear to have developed alongside ultrasound-guidance. Though no serious complications were observed, there appears to be enhanced potential for them to occur with medial angulation and the steep approach. Participants described a loss of anatomical knowledge and a ‘false sense of security’ associated with the adoption of ultrasound-guidance, which may account for the emergence of new, potentially riskier needling techniques.
Conclusion: The introduction of safe technologies may lead to unintended consequences, and clinicians should attempt to recognise and mitigate them when they occur. Education to increase awareness of the pitfalls of ultrasound-guidance is recommended.