Use of Static Ultrasound Guidance for Internal Jugular Vein Cannulation in Adult Cardiac Surgical Patients

Study Overview
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Brief Summary
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Cannulation of the internal jugular vein (IJV) for central venous access is a standard practice in cardiac surgery. In this study, the authors tested the hypothesis that using an ultrasound (US) scanner would increase the success of IJV cannulation and decrease the incidence of complications in adult cardiac surgical patients. The study will include adult cardiac surgical patients, randomized into two groups (control vs. US). In the control group, IJV cannulation will be performed by the conventional landmark technique using Seldinger method. In the US group, the course of the IJV will be marked before cannulation using a 2 - 4 MHz transthoracic echocardiography probe. The success rate, number of attempts, cannulation time and complication rate will be compared for the two groups.

Detailed Description
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Use of real time ultrasound has recently been recommended as the standard of care for insertion of central venous catheters. However, its usage is limited by various factors which include availability, space constraints and perceived lack of need according to surveys including cardiovascular anesthesiologists. We will conduct a prospective randomized controlled trial to compare the conventional landmark technique with the static ultrasound (US) technique that utilized the transthoracic echocardiography (TTE) ultrasound probe which is supplied along with the transesophageal echocardiography machines for internal jugular vein cannulation in adult cardiac surgical patients. After ethical committee approval and patient consent, adult patients scheduled for elective cardiac surgery will be randomized to undergo internal jugular vein cannulation by either of the two methods: standard landmark technique (group A: control group), static US technique using the TTE probe (group B: ultrasound group). The success rate, number of attempts, total cannulation time and complication rate in the two groups will be compared.

Official Title
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Comparison of the Landmark Technique and the Static Ultrasound Guided Technique for Internal Jugular Vein Cannulation in Adult Cardiac Surgical Patients.

Conditions
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Adult Cardiac Surgical Patients

Intervention / Treatment
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* Procedure: landmark technique
* Device: Static Ultrasound technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patients scheduled for elective cardiac surgery Exclusion Criteria: patients undergoing bidirectional Glenn shunt, Fontan surgery or emergency surgery local site infection presence of coagulopathy anatomical deformity of neck(burns, neck swelling, surgical scar)

Ages Eligible for Study
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Minimum Age: 15 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

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Landmark technique<br>The landmark technique is the standard technique used for internal jugular vein cannulation. | Procedure: landmark technique<br>* The apex of the imaginary triangle formed between the two heads of sternocleidomastoid and clavicle was used as the point of needle entry, just lateral to the pulsation of the internal carotid artery and directed towards the ipsilateral nipple at an angle of 45 degrees.<br>|
| Experimental: Static Ultrasound technique<br>Static ultrasound technique was used to assist internal jugular vein cannulation. | Device: Static Ultrasound technique<br>* Static ultrasound guided internal jugular vein cannulation was performed by using the transthoracic echocardiography probe supplied with the transesophageal echocardiography machine in the cardiothoracic surgery operation theatre. The internal jugular vein was located and marked using this method prior to puncture.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| success | Success was defined as location of the IJV by the finder needle within five attempts. | during internal jugular venous cannulation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of attempts by finder/locator needle | The total number of attempts taken to locate the internal jugular vein using the locator/finder needle were measured. | at the time of internal jugular vein cannulation | 
| total number of attempts by puncture needle | The total number of attempts taken by the puncture needle to enter the internal jugular vein were measured. | at the time of internal jugular vein cannulation | 
| First attempt sucess | First attempt success was defined as location of the IJV by finder needle in the first attempt. | at the time of internal jugular vein cannulation | 
| Central venous cannulation time | Time to central venous cannulation (CVC) was defined as the time taken from the insertion of finder needle till de-airing and flushing of all the three ports of the triple lumen catheter. | at the time of internal jugular venous cannulation | 
| ultrasound time | The duration of ultrasound was defined as the time between the placement of the probe on neck till the marking of the course of the vein on the skin. | at the time of internal jugular vein cannulation | 
| total cannulation time | control group: total cannulation time= central venous cannulation time ultrasound group: total cannulation time= central venous cannulation time+ ultrasound time | at the time of internal jugular vein cannulation | 
| complication rate | The complication rate was calculated as a percentage of the total number of complications with respect to the sample size | at the time of central venous cannulation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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internal jugular vein, landmark, ultrasound, static, cardiac surgery