Abstract

Central venous catheterization (CVC) via the internal jugular vein (IJV) is a fundamental procedure in emergency and critical care practice. Traditionally, this has been performed using landmark-based techniques followed by chest X-ray (CXR) to confirm tip placement and rule out complications. However, with the evolution of point-of-care ultrasound (POCUS), the necessity of routine CXR is being reconsidered. This article reviews evidence comparing landmark-guided CVC with postprocedure CXR versus ultrasound-guided CVC with sonographic confirmation. Numerous international studies demonstrate that ultrasound guidance increases first-attempt success rates, reduces procedure-related complications, and allows for immediate confirmation of line position and exclusion of pneumothorax using lung sliding and saline flush echo methods.1-3 In Indian emergency departments (EDs), where ultrasound accessibility and operator training vary, adopting selective CXR strategies tailored to clinical context can optimize both safety and efficiency. The review emphasizes evidencebased practice and supports the integration of POCUS training into ED protocols to enhance procedural outcomes. Introduction: Central venous catheter insertion is an indispensable skill for emergency and critical care physicians. The internal jugular vein (IJV) is preferred due to its predictable anatomy and lower infection risk. Traditionally, cannulation relied on anatomical landmarks with post-procedure CXR for tip confirmation and pneumothorax detection.4 However, real-time ultrasound guidance has become the global standard, endorsed by the National Institute for Health and Care Excellence (NICE) and the Agency for Healthcare Research and Quality (AHRQ) as a best-practice safety measure.5-6

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