The role of ultrasound monitor positioning in internal jugular vein catheterization: A randomized clinical trial on ergonomic optimization

Introduction: Ergonomics in anesthesia aims to optimize the work environment to enhance safety, efficiency, and well-being. Despite published guidelines, workplace ergonomics remains underappreciated, with over 70% of anesthesiologists unaware of specific recommendations. This study investigates whether positioning the ultrasound monitor in the operator’s direct line of sight improves procedural efficiency and safety during centrally inserted central catheters (CICCs) in the internal jugular vein. Methods: This prospective, randomized clinical trial enrolled anesthesia and emergency medicine residents at the University of Padua. Participants were asked to perform CICCs in the internal jugular vein in a simulated setting and were randomly assigned to two groups: frontal (monitor directly in front) or lateral (monitor positioned perpendicularly). The primary outcome was the time required to complete the procedure. Secondary outcomes included failure rate, complication rate (arterial puncture), and ultrasound needle visualization quality. A post-hoc analysis compared low- and high-proficiency subgroups. Results: A total of 239 residents completed the study. No significant difference was observed in completion time or failure rate between groups. However, the lateral group had a significantly higher complication rate (11.6% vs 3.3%, p = 0.012), particularly in the high-proficiency subgroup (16.1% vs 2.2%, p = 0.018). Conclusions: Ergonomic ultrasound monitor positioning reduces complication rates during CICCs placement without affecting procedure duration or success rates. These findings support integrating ergonomic principles into clinical training. However, further studies are needed to confirm these benefits in real-world settings and across different procedures.