Central Venous Catheter Insertion Techniques

Catheterization, Central Venous Clinical Trial

Official title:

Internal Jugular Vein Cannulation: A Comparison Of Three Techniques: Anatomical Landmark, US Guided Prelocation, and Ultrasound Guided Real Time, at Tertiary Care Teaching University Hospital

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05387486
• Other study ID #: 3488-Ane-ERC-15
• Status: Completed
• Phase: N/A
• Start date: August 1, 2019
• Est. completion date: July 4, 2021

Study information

• Verified date: July 2023
• Source: Aga Khan University Hospital, Pakistan
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Investigator compared three techniques of Central venous cannulation (CVC) insertion, Anatomical Landmark, Pre-location Ultrasound and the Real Ultrasound techniques, in cardiac surgical patients.

Description:

Central venous cannulation (CVC) is the cannulation of a large central vein in neck (internal jugular vein), chest (subclavian or axillary) or groin (femoral vein). It is a standard clinical method performed for the monitoring of central venous pressure, temporary haemodialysis, drug administration (drugs irritating peripheral veins, chemotherapy, concentrated vasoactive drugs ) rapid infusion of fluids, inadequate peripheral intravenous access and sampling site for repeated blood sampling. There are different techniques for Central venous cannulation which include anatomical landmark and ultrasound guided (USG) technique.

Previous studies have shown that the successful IJV cannulation using anatomical landmark technique was 85% as compared to ultrasound guided IJV cannulation which was 95%.The median catheterisation time of internal jugular vein via ultrasound guided (USG) is shorter than anatomical landmark technique.

There has been little evidence regarding the use of ultrasound guidance for internal jugular vein cannulation at a tertiary care hospital in our population. Furthermore with widespread availability of ultrasound, Internal Jugular vein can be successfully cannulated with decreasing number of attempts, less time consumption and decrease in the incidence of complications.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 201
• Est. completion date: July 4, 2021
• Est. primary completion date: April 1, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Age 18-65 years

• ASA (American society of Anesthesiologists) status 1 to 3 requiring central venous catheter during surgical procedure

• ASA (American society of Anesthesiologists) status 4 patients coming for cardiac surgery

Exclusion Criteria:

Patients with a history of following

• Previous head and neck surgery

• Head and neck mass or cancer.

• Superior vena cava syndrome.

• Coagulopathy.

• Infection at the cannulation site.

• Previous central venous access.

• Anatomical Changes due to surgery or any pathology in the neck which can lead to distortion of anatomical land marks in the region of puncture.

• Raised intracranial pressure (ICP).

• Patients coming for emergency surgery

• Patients with BMI (Body Mass Index) more than 30

• Patient refusal

Related Conditions & MeSH terms

• Catheterization, Central Venous

Intervention

Procedure:
• Anatomical Landmark technique
anatomical landmarks (sternocleidomastoid muscles, sternal notch, cricoid cartilage, carotid artery and clavicle) will be palpated. A 3cc syringe with 21 gauge needle (locator) will be used first to locate IJV at the apex of the triangle formed by the two heads of the sternocleidomastoid muscle. After successful location, an introducer needle of 18 gauge, attached with a 5 ml syringe, will be inserted at the same point. The introducer needle will be directed towards the ipsilateral nipple at an angle of 20-30° with the skin
• Ultrasound-guided pre location technique
In Group Ultrasound-guided pre location technique, venipuncture site will be determined using ultrasound probe which will be then removed and locator needle of 21 gauge will be used first to confirm IJV location. The cannulation or venipuncture will be performed at the marked point of locator needle by the use of 18 gauge introducer needle.
• Ultrasound-guided real-time technique
In Group Ultrasound-guided real-time technique, cannulation or venipuncture will be performed under real-time imaging using 18 gauge needle i-e ultrasound will be used for prelocation and puncturing of IJV and locator needle will not be used

Locations

Country	Name	City	State
Pakistan	Aga Khan University hospital	Karachi	Sindh

Sponsors (1)

Lead Sponsor	Collaborator
Aga Khan University Hospital, Pakistan

Country where clinical trial is conducted

Pakistan, 

References & Publications (3)

Kaye AD, Fox CJ, Hymel BJ, Gayle JA, Hawney HA, Bawcom BA, Cotter TD. The importance of training for ultrasound guidance in central vein catheterization. Middle East J Anaesthesiol. 2011 Feb;21(1):61-6. — View Citation

Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med. 2006 Nov;48(5):540-7. doi: 10.1016/j.annemergmed.2006.01.011. Epub 2006 Feb 21. — View Citation

Ray BR, Mohan VK, Kashyap L, Shende D, Darlong VM, Pandey RK. Internal jugular vein cannulation: A comparison of three techniques. J Anaesthesiol Clin Pharmacol. 2013 Jul;29(3):367-71. doi: 10.4103/0970-9185.117115. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Success Rate	Success rate will be measured according to the number of attempts. The cannulation of right Internal Jugular Vein within the first three attempts.	Day 1
Secondary	Time duration for each technique	Measurment of time in minutes	Day 1
Secondary	Incidence of Complications	Look for carotid puncture, haematoma formation , pneumothorax	Day 1