Clinical trial NCT03812757: Supraclavicular Fossa US View for Catheter Positioning in Right Subclavian Central Venous Catheterization
Official title: The Supraclavicular Fossa Ultrasound View for Correct Catheter Positioning in Infraclavicular Right Subclavian Central Venous Catheterization
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Central Venous Catheter Placement
Keywords: Central venous catheter
Subclavian vein
Supraclavicular fossa ultrasound view
Lead sponsor: Skane University Hospital
Sponsor class: OTHER
First posted: 2019-01-23
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients \>18 years with an indication for CVC placement and under the care of one of three intensivists responsible for the study will be consecutively included in the study

Brief summary: The study will evaluate if the supraclavicular fossa ultrasound view can be used to achieve a correct catheter tip placement in infraclavicular right subclavian central venous catheter placement. This may make routine post-procedural x-ray exams redundant.

Detailed description: Central venous catheterization is one of the most common procedures within intensive care medicine. Verification of correct catheter tip placement is a primary aspect of safety and quality of central venous catheterization as malposition may lead to life-threatening complications such as thrombosis, hemothorax, cardiac tamponade, and arrhythmias. Conventional chest x-ray (CXR) is routinely performed after every insertion and is considered gold standard to examine catheter tip location and evaluate for complications such as pneumo- and hemothorax. However, CXR exposes the patient to ionized radiation, requires a considerable amount of time, and is workload-generating for both ICU and radiology staff.

Weber et al has described the use of the right supraclavicular fossa view for real-time ultrasound-guided placement of a central venous catheter (CVC) via the right internal jugular vein (IJV) in adults. This approach has subsequently been validated in a clinical study and has also been used for supraclavicular subclavian line insertion. The approach requires use of a microconvex probe, which couples good image resolution and high scanning depth. The use of a microconvex probe for infraclavicular subclavian central venous catheter (CVC) insertion has been described previously, but this is the first description of the supraclavicular fossa ultrasound view to guide correct catheter tip placement in infraclavicular right subclavian CVC placement.

Eligibility criteria: Inclusion Criteria:

* Indication for central venous catheter placement.

Exclusion Criteria:

* Operator unable to visualize the subclavian vein (e.g., in those with subcutaneous emphysema of the chest wall),
* Subclavian vein catheterization deemed inappropriate by the operator,
* Central line/pacemaker/similar device already in place (risk for misinterpretation of the ultrasound image)

Primary outcomes:
measure: Correct catheter tip positioning
timeFrame: Post-procedural x-ray (typically within 24 hours)
Secondary outcomes:
measure: Mechanical complications within 24 hours
timeFrame: Within 24 hours after central venous catheterization
Other outcomes:
Locations:
city: Lund
country: Sweden
facility: Skånes universitetssjukhus
Study officials:
affiliation: Skane University Hospital
name: Ola Borgquist, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Adrian M, Kander T, Lunden R, Borgquist O. The right supraclavicular fossa ultrasound view for correct catheter tip positioning in right subclavian vein catheterisation: a prospective observational study. Anaesthesia. 2022 Jan;77(1):66-72. doi: 10.1111/anae.15534. Epub 2021 Jul 14.