Clinical trial NCT05387486: Central Venous Catheter Insertion Techniques
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Catheterization, Central Venous
Keywords: Cardiac Surgery
Central Venous Catheter
Anatomical Landmark
Ultrasound
Lead sponsor: Aga Khan University Hospital, Pakistan
Sponsor class: OTHER
First posted: 2022-05-24
Enrollment: 201
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Success Rate
timeFrame: Day 1
Secondary outcomes:
measure: Time duration for each technique
timeFrame: Day 1
measure: Incidence of Complications
timeFrame: Day 1
Other outcomes:
Locations:
city: Karachi
country: Pakistan
facility: Aga Khan University hospital
state: Sindh
Study officials:
References:
citation: Ray BR, Mohan VK, Kashyap L, Shende D, Darlong VM, Pandey RK. Internal jugular vein cannulation: A comparison of three techniques. J Anaesthesiol Clin Pharmacol. 2013 Jul;29(3):367-71. doi: 10.4103/0970-9185.117115.
citation: Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med. 2006 Nov;48(5):540-7. doi: 10.1016/j.annemergmed.2006.01.011. Epub 2006 Feb 21.
citation: Kaye AD, Fox CJ, Hymel BJ, Gayle JA, Hawney HA, Bawcom BA, Cotter TD. The importance of training for ultrasound guidance in central vein catheterization. Middle East J Anaesthesiol. 2011 Feb;21(1):61-6.