To Compare the In-plane and Out of Plane Ultrasound Guided Approach for Internal Jugular Vein Cannulation in the Patients Undergoing Elective Cardiac Surgery.

Study Overview
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Brief Summary
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The insertion of central venous catheters (CVCs) has become an integral part of management of a critically ill patient. Access to the central vein may be required for the administration of hyper osmotic or vasoactive compounds, parenteral nutrition, and rapid infusion of large volumes of fluid or for the continuous or intermittent monitoring of biochemical or physiological parameters. Central venous catheter insertion is also indicated when the insertion of a peripheral line is not possible. Traditionally, CVC insertions have been performed using the landmark technique. Considering the number of CVCs being inserted every day, this can amount to a large number of complications. Efforts to minimize and prevent the occurrence of complications should be a routine component of quality improvement programs. There is an increasing body of evidence supporting the use of ultrasound guidance for CVC placement. This makes the strong rationale to conduct this research thus the aim of this study is to evaluate the real benefits i.e outcome of Long versus Short Axis ultrasound guided approach for internal jugular vein cannulation in the patient for elective cardiac surgery as central venous cannulation (CVC).

Detailed Description
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OBJECTIVE: To compare the in plane and out of plane ultrasound guided approach for internal jugular vein cannulation in the patients undergoing elective cardiac surgery. Ultrasound-guided central vein cannulation has many advantages, giving the operator the possibility of choosing the most appropriate and safest venous access on the basis of ultrasound assessment, performing a 100% safe insertion, ruling out malposition or pleuropulmonary damages, during and after the procedure. There is an increasing body of evidence supporting the use of ultrasound guidance for CVC placement. This makes the strong rationale to conduct this research thus the aim of this study is to evaluate the real benefits i.e outcome of Long versus Short Axis ultrasound guided approach for internal jugular vein cannulation in the patient for elective cardiac surgery as central venous cannulation (CVC).

Official Title
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To Compare the In-plane and Out of Plane Ultrasound Guided Approach for Internal Jugular Vein Cannulation in the Patients Undergoing Elective Cardiac Surgery. A Prospective Randomize Control Trial.

Conditions
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Catheterization, Central Venous, Ultrasonography, Cardiac Surgical Procedures

Intervention / Treatment
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* Procedure: In-plane Axis
* Procedure: Out of plane Axis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted for elective cardiac surgery. Age between 18 - 75 years. Exclusion Criteria: BMI more than 30. Haemodynamically unstable. Patient with abnormal coagulation profile(INR>1.5 or Platelet counts<50,000). Patient with a short neck. Patient with carotid Atherosclerosis proven on ultrasound.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Out of plane/ short axis central venous cannulation<br>In a short-axis view, the image plane is perpendicular to the course of the vessel and to the needle (needle is out of plane). The vessel appears as an anechoic circle on the screen of ultrasound with the needle visualized as a hyperechoic point in cross-section. The central venous cannulation was done in out of plane axis. | Procedure: In-plane Axis<br>* In a long-axis view, the image plane is parallel to the course of the vessel (needle is in-plane). The image shows the course of the vessel across the screen and the shaft and point of the needle as it is advanced. The central venous cannulation was done in in-plane axis.<br>|
| Active Comparator: In-plane/long axis central venous cannulation<br>In a long-axis view, the image plane is parallel to the course of the vessel (needle is in-plane). The image shows the course of the vessel across the screen and the shaft and point of the needle as it is advanced. The central venous cannulation was done in in-plane axis. | Procedure: Out of plane Axis<br>* In a short-axis view, the image plane is perpendicular to the course of the vessel and to the needle (needle is out of plane). The vessel appears as an anechoic circle on the screen of ultrasound with the needle visualized as a hyperechoic point in cross-section. The central venous cannulation was done in out of plane axis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| First pass success Rate | Recoded in percentage. Needle successfully inserted into the internal jugular vein and there is no need of Readjustment | immediately after end of procedure | 
| Duration of procedure | Recorded in seconds | Intraoperative (after skin prick to ultrasound confirmation of presence of guide wire within internal jugular vein) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unintentional carotid puncture | Recorded in percentage | immediately after completion of procedure |