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NCT Number: NCT06761326

Right Versus Left Distal Axillary Vein Cannulation

Central venous cannulation is an essential procedure in the anaesthetic and critical care practice. Ultrasound has revolutionized the practice favoring the internal jugular cannulation to the other sites .Subcalvian vein cannulation has fallen out of favor mainly due to the difficult visualization with the ultrasound, especially in obese patients and the inevitable position of the clavicle acting as a bony obstacle , in addition to the anatomical position in vicinity to the pleura which might raise the risk of pneumothorax . Indeed the subclavian vein cannulation is more comfortable and tolerated by the patient especially those requiring long term intravenous therapy, with less rates of infection and thrombosis. This mandated the development of a safer and efficient technique for the cannulation empowered by the ultrasound technology.

The infracalvicular approach or the proximal axillary vein cannulation has been described but is not popular. It provides a potentially safer and successful technique with less complication both in "experienced" and "less experienced"operators . All the patients will receive general anaesthesia with laryngeal mask insertion . Careful sterilization of the surgical site and strict aseptic techniques for the handling of the ultrasound probe will be pursued

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Key information

Conditions

Infraclavicular Vein Cannulation Venous Cannulation

Age range

20 year–70 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Medical Research Institute

Alexandria, Alexandria Governorate, 21561, Egypt

Location status: Recruiting

Location contact

khaled Matarawy, MD

CONTACT

[email protected]

02034282331

About this study

All patients will be in supine position, with the arm abducted to 45 degrees , the angle of the arm will be adjusted to acquire best image. The probe will be placed in he parasagittal plane in the deltopectoral groove medial to the coracoid process . The image will be optimized regarding the depth , focus and the gain accordingly for the best image of the axillary artery and vein similar to that acquired when performing an infraclavicular approach for brachial plexus block . The probe will be rotated to obtain a longitudinal image of the axillary vein . The needle will be introduced in real time imaging , in an in-plane technique and blood will be aspirated , the guidewire will be introduced in real time imaging .The internal jugular vein will be scanned bilaterally via ultrasonography to exclude malposition of the guidewire and will be reported in case of such. The catheter will be introduced through the sheath and will be tunneled the skin, Infraclavicular incision will be performed for the port site , the port will be secured in a dissected pocket right above the pectoralis major muscle .Flush back will be confirmed from the port .The incision will be closed in layers .The final position of the catheter tip will be confirmed using fluoroscopic guidance. In case of difficult visualization or failure of cannulation of one side , the subclavian vein of the contralateral side will be scanned and cannulated . The internal jugular vein will be the cannulated instead if any further difficulties were encountered .

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

.Patients requiring porta Cath insertion.

Exclusion criteria

  • Abnormalities in the platelet count or coagulation
  • Thrombosis of the target vein
  • Soft tissue infection of the overlying area
  • Fracture of the clavicle or proximal ribs
  • Patients with pacemakers or defibrillators
  • Malignant superior vena cava syndrome
  • Gross obesity
  • History of prior catheterization of the subclavian vein
  • Patient refusal to participate in the study.

Treatment and study plan

Ultrasound guided right infraclavicular approach of subclavian vein cannulation

Procedure

All patients will be in supine position, with the arm abducted to 45 degrees , the angle of the arm will be increased to 90 degrees to best acquire the image.The probe will be placed in he parasgittal plane in the deltopectoral groove medial to the coracoid process . The image will be optimized regarding the depth , focus and the gain accorgingly for the best image of the axillary artery and vein similar to that acquired when performing an infraclavicular approach for brachial plexus block . The probe will be rotated to obtain a longitudinal image of the axillary vein . The needle will be introduced in real time imaging , in an inplane technique and blood will be aspirated , the guidewire will be introduced in real time imaging.The internal jugular vein will be scanned bilaterally via ultrasonography to exclude malposition of the guidewire and will be reported in case of such. The catheter will be introduced through the sheath and will be tunneled the skin.

Ultrasound guided left infraclavicular approach of subclavian vein cannulation

Procedure

All patients will be in supine position, with the arm abducted to 45 degrees , the angle of the arm will be increased to 90 degrees to best acquire the image.The probe will be placed in he parasgittal plane in the deltopectoral groove medial to the coracoid process . The image will be optimized regarding the depth , focus and the gain accorgingly for the best image of the axillary artery and vein similar to that acquired when performing an infraclavicular approach for brachial plexus block . The probe will be rotated to obtain a longitudinal image of the axillary vein . The needle will be introduced in real time imaging , in an inplane technique and blood will be aspirated , the guidewire will be introduced in real time imaging.The internal jugular vein will be scanned bilaterally via ultrasonography to exclude malposition of the guidewire and will be reported in case of such. The catheter will be introduced through the sheath and will be tunneled the skin.

Primary outcomes

  1. Incidence of Successful cannulation

    Time frame: Directly after the end of the procedure

    Recognition of the catheter in the SVC by fluoroscopy

Secondary outcomes

  1. Rate of malposition identified by the ultrasound

    Time frame: Directly after the insertion of the guidewire and the catheter

    The ultrasound probe will be positioned on the internal jugular vein for the recognition of malposition of the guidewire

  2. Complication of the procedures

    Time frame: Directly at the end of the procedure

    All the complications will be recognized and reported

Study contacts

Contact information is provided by the study sponsor or research team.

Engi y Hashem, MD

CONTACT

[email protected]

0201223372319

Wessam Z ElAmrawy, MD

CONTACT

[email protected]

0201280998606

Sponsors and collaborators

Lead sponsor

Alexandria University

Other

Registry information

Official study title

Right Versus Left Ultrasound-Guided Distal Axillary Vein Cannulation : A Prospective Randomized Study

Important dates

Study start
2024
Primary completion
2026
Study completion
2026
First posted
Jan 7, 2025
Registry last updated
Jun 17, 2026

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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