Central Venous Catheter Insertion Techniques
Condition: Catheterization, Central Venous
Study type: Interventional

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

Detailed description: 
      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.
    

Intervention name(s): Anatomical Landmark technique; Ultrasound-guided pre location technique; Ultrasound-guided real-time technique
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): 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; 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.; 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
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Cardiac Surgery; Central Venous Catheter; Anatomical Landmark; Ultrasound