Central Venous Catheter Insertion Techniques

Study Overview
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Brief Summary
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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
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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.

Official Title
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Internal Jugular Vein Cannulation: A Comparison Of Three Techniques: Anatomical Landmark, US Guided Prelocation, and Ultrasound Guided Real Time, at Tertiary Care Teaching University Hospital

Conditions
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Catheterization, Central Venous

Intervention / Treatment
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* Procedure: Anatomical Landmark technique
* Procedure: Ultrasound-guided pre location technique
* Procedure: Ultrasound-guided real-time technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-65 years ASA (American society of Anesthesiologists) status 1 to 3 requiring central venous catheter during surgical procedure ASA (American society of Anesthesiologists) status 4 patients coming for cardiac surgery Exclusion Criteria: Patients with a history of following Previous head and neck surgery Head and neck mass or cancer. Superior vena cava syndrome. Coagulopathy. Infection at the cannulation site. Previous central venous access. Anatomical Changes due to surgery or any pathology in the neck which can lead to distortion of anatomical land marks in the region of puncture. Raised intracranial pressure (ICP). Patients coming for emergency surgery Patients with BMI (Body Mass Index) more than 30 Patient refusal

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: ALT<br> | Procedure: Anatomical Landmark technique<br>* 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<br>|
| Active Comparator: USG-Pre<br> | Procedure: Ultrasound-guided pre location technique<br>* 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.<br>|
| Active Comparator: USG -RT<br> | Procedure: Ultrasound-guided real-time technique<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success Rate | Success rate will be measured according to the number of attempts. The cannulation of right Internal Jugular Vein within the first three attempts. | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time duration for each technique | Measurment of time in minutes | Day 1 | 
| Incidence of Complications | Look for carotid puncture, haematoma formation , pneumothorax | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac Surgery, Central Venous Catheter, Anatomical Landmark, Ultrasound