Pregnancy Clinical Trial
Official title:
Internal Jugular Vein and Carotid Artery Anatomic Relation as Determined by Ultrasonography in Obstetric Patients
There is no data regarding success rates and incidence of carotid punctures during central venous cannulation (CVC) in the pregnant patients. We hypothesize that because of the anatomical and physiological changes associated with pregnancy, these patients are at higher risk of procedure failure and carotid puncture than the general population. The purpose of our study is to determine the success rate and incidence of carotid punctures using an ultrasound-simulated procedure in pregnant and non-pregnant patients.
There is no data regarding success rates and incidence of carotid punctures during central
venous cannulation (CVC) in pregnant patients. We hypothesize that because of the anatomical
and physiological changes associated with pregnancy, these patients are at higher risk of
procedure failure and carotid puncture than the general population. The purpose of our study
is to determine the success rate and incidence of carotid punctures using an
ultrasound-simulated procedure in pregnant and non-pregnant patients.
Pregnant patients and adult female volunteers (controls) were recruited. Subjects were
placed supine with wedge under the right hip, and head turned 35 degrees to the left. Two
different approaches for CVC, the central landmark and the palpatory approach were used. The
ease of identification of the landmarks was noted. CVC was simulated using an ultrasound
probe, on pre-marked points. Ultrasound images were obtained, within the same parasagittal
plane, directed 30 degrees caudad, in a manner simulating how a syringe and needle would be
placed for central venous cannulation. The investigator placing the probe was blinded to the
image being generated. The vertical cursor of the ultrasound, which serves to delineate the
path of a needle, was placed in the image. If the cursor intersects the vein, the attempt is
considered successful. If the first attempt is not successful, the investigator placing the
probe was asked to redirect the probe to the second and if necessary to the third marked
point. This was done for each approach. If the cursor intersects the carotid artery, the
attempt is considered an accident and no further attempts were made. In addition to
determining the success rate and the incidence of carotid punctures, the relative position
of vein and artery was studied in each patient. For each approach, the best image was
recorded, and three experienced anesthesiologist scored the images for vein and artery
degree of overlapping.
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Time Perspective: Prospective
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