Comparison of Two Needle Insertion Techniques on Success Rate and Complications During Central Venous Catheterization
Condition: Complications of Central Venous Catheterization
Study type: Interventional

Summary: 
      The purpose of this study is to compare two needle insertion techniques(Seldinger vs.
      modified Seldinger technique) on success rate and complications during central venous
      catheterization.
    

Detailed description: 
      Unintended arterial puncture and local hematoma formation are the most common complications
      during internal jugular vein central venous catheterization. Other serious complications like
      pseudoaneurysm, arteriovenous fistula, arterial dissection, thrombosis, embolism are also
      possible. These complications mostly occur by mechanical trauma or injury when advancing
      needle back and forth to puncture internal jugular vein. Placement of guidewire or dilator
      can also cause mechanical trauma or injury around the vessel.

      Because internal jugular vein collapses easily during needle advance, anterior and posterior
      wall of the vessel can be punctured simultaneously. Posterior wall puncture can increase the
      risk of complications of the catheterization. Delicate puncture of the vessel and stable
      fixation of the needle after puncture are important to reduce overall number of
      catheterization attempts, increase success rate, reduce complications.

      Seldinger technique(thin-wall needle technique) is commonly used procedure to obtain safe
      access to central vein. The desired vessel is punctured with a sharp hollow needle, syringe
      is detached and guidewire is advanced through the lumen of the needle, and then the needle is
      withdrawn. Central catheter is then passed over the guidewire into the vessel. Contrarily,
      modified Seldinger technique(guiding sheath-over-the-needle technique) use needle that is
      covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid
      over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the
      guiding sheath, central catheter is placed into the vessel.

      When using Seldinger technique, it is important to fix the needle firmly with hand until the
      guidewire is placed into the vessel lumen. If hand fixation is not stable, needle tip can
      migrate from the lumen, can pierce the vessel wall, and carotid artery puncture, and local
      hematoma formation might occur. Even if there is no evidence of complications, when blood
      regurgitation fails, overall number of vessel puncture attempts would increase and it is
      expected that rate of complications of the catheterization would increase.

      When using modified Seldinger technique, guiding sheath is easily slid over the needle,
      providing stable route into the vessel lumen relatively in early step of the catheterization.
      Therefore, it is expected that stability of the fixation improves, success rate of the
      catheterization increase, and complications of the catheterization decrease. But there is no
      high level of evidence yet, and still decision to use which technique is based on experience
      of the operator.

      Investigators are going to compare the Seldinger technique and modified Seldinger technique
      on success rate and complications during central venous catheterization by prospective,
      randomized, controlled study.
    

Intervention name(s): modified Seldinger technique; Seldinger technique
Intervention type(s): Procedure; Procedure
Intervention description(s): modified Seldinger technique(guiding sheath-over-the-needle technique) use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel.; The desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Central Venous Catheterization