Central Venous Catheter Insertion Techniques

Aga Khan University Hospital, Pakistan

Status: Completed

Conditions: Catheterization, Central Venous

Treatments: Procedure: Ultrasound-guided real-time technique; Procedure: Anatomical Landmark technique; Procedure: Ultrasound-guided pre location technique

Study type: Interventional

Funder types: Other

Identifiers

NCT05387486

3488-Ane-ERC-15

Details and patient eligibility

About

Investigator compared three techniques of Central venous cannulation (CVC) insertion, Anatomical Landmark, Pre-location Ultrasound and the Real Ultrasound techniques, in cardiac surgical patients.

Full 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.

Enrollment: 201 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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201 participants in 3 patient groups

ALT

Active Comparator group

Treatment:

Procedure: Anatomical Landmark technique

USG-Pre

Active Comparator group

Treatment:

Procedure: Ultrasound-guided pre location technique

USG -RT

Active Comparator group

Treatment:

Procedure: Ultrasound-guided real-time technique