3D Guided Internal Jugular Vein Catheterization
Condition: Catheter Related Complication; Ultrasound; Complications
Study type: Interventional

Summary: 
      Central venous catheterization through the jugular vein is a standard procedure for
      cardiothoracic surgical patients. Ultrasound (US) guidance is preferred and compared to
      traditional landmark approach decreases complications and increases success rate. Both long
      and short axis views are used for obtaining access, both with their own advantages and
      shortcomings. Complications have also not completely diminished with the use of US. The
      investigators propose a new technique using 3D biplanar imaging, combining advantages from
      both long and short axis views in one image, enabling more successful procedures and a lower
      complication rate
    

Detailed description: 
      Central venous catheters (CVC) are frequently placed in patients who are scheduled for
      cardiothoracic surgery (ICU). Ultrasound (US) guidance has consistently shown to not only
      improve success rate of procedures, but also to decrease complications with most benefit for
      the jugular vein. However, serious adverse events still occur despite US guidance
      Conventional two dimensional ultrasound (2D US) guided access if performed in either the
      short axis or long axis view, with both approaches having their own limitations. Using short
      axis view, the operator is never certain of the position of the needle tip as the shaft of
      the needle is not distinguishable from the tip in this view. Structures not (yet) visible in
      the US screen can already be punctured, or a vessel can be entered at a different position
      than preferred. A possible mechanism through which carotid artery puncture can happen is the
      posterior wall puncture4.

      For long axis view, with proper technique the needle is viewed entirely during the procedure.
      However, this requires extensive experience and the overview of surrounding structures is
      lost.Multiple attempts at improving US guided venous access have been tried, such as oblique
      visualization or alternating short and long axis views but those approaches still have their
      shortcomings.

      Three dimensional ultrasound (3D US) has a theoretical advantage of increased anatomical
      awareness, but evidence of improvement in needle based procedures is scarce.

      Recently, a new 3D US probe is introduced which can address the above mentioned limitations
      of 2D US for access procedures.

      The investigators hypothesize that this superior three dimensional awareness can improve
      needle placement during central venous catheterization, increasing success rates and
      potentially decreasing complications.
    

Intervention name(s): 3DUS biplanar catheterization; 2D US catheterization
Intervention type(s): Device; Device
Intervention description(s): biplanar view of both short and long axis view of the internal jugular vein improves anatomical awareness and potentially improves safety of venous catheterization; 2D short axis internal jugular vein catheterization
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized clinical trial (RCT)
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: ultrasound; internal jugular vein; cardiothoracic surgery