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Completed

NCT Number: NCT05387486

Central Venous Catheter Insertion Techniques

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

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Key information

Conditions

Catheterization, Central Venous

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Aga Khan University hospital

Karachi, Sindh, 74800, Pakistan

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Anatomical Landmark technique

Procedure

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

Procedure

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

Procedure

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

Primary outcomes

  1. Success Rate

    Time frame: Day 1

    Success rate will be measured according to the number of attempts. The cannulation of right Internal Jugular Vein within the first three attempts.

Secondary outcomes

  1. Time duration for each technique

    Time frame: Day 1

    Measurment of time in minutes

  2. Incidence of Complications

    Time frame: Day 1

    Look for carotid puncture, haematoma formation , pneumothorax

Sponsors and collaborators

Lead sponsor

Aga Khan University Hospital, Pakistan

Other

Registry information

Official study 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

Important dates

Study start
2019
Primary completion
2021
Study completion
2021
First posted
May 24, 2022
Registry last updated
Aug 1, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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