US-guided OOP Internal Jugular Vein Vs IP Supraclavicular Subclavian Vein Catheterization in ICU

Study Overview
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Brief Summary
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Patients were randomly divided into two groups: ultrasound-guided (US-guided) out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSV) catheterization. For OOP-IJV cannulation, the transducer was placed to identify IJV in short-axis view. The needle was introduced at an angle of 60° to the skin surface, and advanced under real-time US guidance until visualizing the tip of the needle inside the vein. For IP-SSV cannulation, a short-axis view of the IJV was obtained first. The probe was slid caudally following the IJV until getting the best long-axis view of the SCV. Using an in-plane approach, the needle was inserted at the base of the transducer at a 30° angle and advanced under the long axis under real-time US guidance targeting the SCV.

Detailed Description
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Patients were randomly divided into two groups: ultrasound-guided (US-guided) out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSV) catheterization. For OOP-IJV cannulation, the transducer was placed on transverse position over the patient's neck at the level of the cricoid cartilage to identify IJV and carotid artery (CA) in short-axis view. The vein was then centered on the screen. The skin puncture was made in the center of the US image using a needle attached to a syringe. The needle was introduced at an angle of 60° to the skin surface, perpendicular to the transducer, and advanced under real-time US guidance toward the IJV until visualizing the tip of the needle inside the vein. For IP-SSV cannulation, a short-axis view of the IJV was obtained first. The probe was slid caudally following the IJV until the junction of the subclavian vein (SCV) and IJV was reached in the supraclavicular fossa. The probe was then turned slightly and tilted anteriorly to get the best long-axis view of the SCV and the brachiocephalic vein (BCV). Using an in-plane approach, the needle attached to a syringe was inserted at the base of the transducer at a 30° angle and advanced strictly under the long axis of the US probe from lateral to medial. The needle point was then guided under real-time US guidance targeting the SCV. In both groups, catheterization was done through Seldinger technique.

Official Title
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Comparison Between Ultrasound-guided Out-of-plane Internal Jugular Vein and In-plane Supraclavicular Subclavian Vein Catheterization in Intensive Care Unit Patients-a Randomized Trial

Conditions
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Central Venous Catheter

Intervention / Treatment
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* Device: Catetherization approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted in intensive care unit requiring a central venous catheter (CVC) Exclusion Criteria: Major blood coagulation disorders, Any thrombotic formations within the vein, Congenital or acquired deformity of neck or clavicle Cannulation site infection, hematoma and surgery.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: OOP-IJV<br>Out of plane inetrnal jugular vein catetherization | Device: Catetherization approach<br>* Out of plane inetrnal jugular vein Vs in plane supraclavicular subclavian vein catetherization<br>|
| Other: IP-SSV<br>in plane supraclavicular subclavian vein catetherization | Device: Catetherization approach<br>* Out of plane inetrnal jugular vein Vs in plane supraclavicular subclavian vein catetherization<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The overall access time | Time from the ultrasound scanning to the ultrasound confirmation of the correct position of the guidewire into vein. | During the venous cannulation procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The guidewire time | Time from the first skin puncture to the ultrasound confirmation of the correct placement of the guidewire into the vein. | During the venous cannulation procedure | 
| The venous access time | The time between the first skin puncture and free aspiration of venous blood in the syringe | During the venous cannulation procedure |