Short Versus Long Axis Ultrasound Guided Approach for Internal Jugular Vein Cannulations
Condition: Ultrasonography; Central Line Complication
Study type: Interventional

Summary: 
      We plan to compare single person short axis view with two person long axis view
    

Detailed description: 
      Introduction: The guidelines for the use of bedside ultrasonography in the evaluation of
      critically ill patients published by the society of critical care medicine recommends
      short-axis view be used during insertion of central venous catheter (CVC) in internal jugular
      vein (IJV) to improve success rate1. The long axis view is considered better for cannulations
      as it helps in preventing posterior wall puncture but in the trials it has been found to be
      inconvenient for a single user2,3. We hypothesise that if two persons perform long axis
      cannulations i.e. one person will image the vein while the other punctures it will be equally
      convenient to single person doing the cannulations in short axis. The advantage we expect to
      see is lesser complications in long axis group.

      Methodology:

      Inclusion criteria: Any patient getting admitted to ICU and requiring central venous
      cannulations.

      Exclusion: Lack of consent. Randomization: At a 1:1 ratio, to be achieved using a
      computer-generated random number sequence for 100 consecutive subjects Study intervention:
      Eligible patients will be randomized to a short-axis or long axis technique for ultrasound
      guided IJV cannulations. Ultrasound guidance will be performed dynamically using a
      single-operator technique for short axis and double operator technique for long axis view.
      Cannulations and USG is to be carried out by 2 trained Anaesthesiologists.

      Definition:

        1. Insertion time: Time taken from 1st puncture of skin to insertion of guide wire into the
           vein.

        2. Total Procedure time: Time from when Ultrasound scan was started to complete suturing of
           the CVC line.

        3. Number of needle sticks: Number of time punctures were done in the skin. Complications
           were noted as hematoma formation, posterior wall puncture, arterial puncture,
           extravasations of blood and pneumothorax.

      All the times are to be noted by a bedside nurse who is not involved in the trial or knows
      the study hypothesis.

      Statistical Analysis: An intention-to-treat analysis was performed. Insertion time, overall
      procedure time and number of needle sticks, and will be compared using Mann-Whitney U tests.
      The success rate and complication rate will be compared using Fisher exact tests. All
      statistical analyses will be performed with SPSS 20.0
    

Intervention name(s): Ultrasonography
Intervention type(s): Device
Intervention description(s): Ultrasound guidance for central line
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: patient to be randomized to two groups
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: central line; Central Line Complication