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Long-versus Short-Axis Ultrasound Guidance for Subclavian Vein Cannulation

A

Azienda Ospedaliero-Universitaria di Parma

Status

Completed

Conditions

Vascular Access Complication
Perioperative/Postoperative Complications

Treatments

Device: Short Axis Strategy
Device: Long Axis strategy

Study type

Interventional

Funder types

Other

Identifiers

Details and patient eligibility

About

Central venous catheterization is commonly applied in patients undergoing cardiac surgery. The subclavian vein has lower risk of infection and provides more patients comfort. However central venous catheterization may results in complications such as pneumothorax, hemothorax or arterial puncture. It has been suggested that ultrasound (US) guidance could improve the success rate, reduce the number of needle passes and decrease complications. Two different real-time 2-dimensional US techniques can be employed in the insertion of central venous catheters. The first technique involves real-time US-guided cannulation of subclavian vein using a long axis/in-plane approach. The second one involves real-time US-guided using a short axis/out-off-plane approach. However to date no studies have compared their efficacy and safety. The purpose of this study was to compare the US-guided long-axis versus short-axis approach for the SCV catheterization in adult critical care patients.

Full description

The two techniques used for vessel visualization are far different:

The Short-Axis (SA) approach attempts to view the vessel in cross-section while venous access is obtained. The strength of the SA approach is that the vein is centered under the transducer and that the midpoint of the transducer becomes a reference point for the insertion of the needle, and that at the same time is possible to visualize SC artery and the pleural line. SA approach is easy to learn by novice sonologists.

The Long-Axis (LA) approach employs a technique that views the length of the vessel during cannulation.For this reason, with LA approach is possible to visualize the needle advance during the entire procedure from the soft tissues until the lumen of the vein, but SC artery and pleural line are not visualized in the same scan. For LA approach, practice is required to keep the needle precisely within the image and care must be taken to avoid the probe inadvertently moving away from the target structure.

Enrollment

190 patients

Sex

All

Ages

18 to 85 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • aged =>18 years
  • patients who needed central venous catheter for clinical reasons

Exclusion criteria

  • aged <18a years

Trial design

Primary purpose

Supportive Care

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

190 participants in 2 patient groups

Long Axis strategy
Active Comparator group
Description:
The central venous catheterization will be performed by the long axis approach
Treatment:
Device: Long Axis strategy
Short Axis Strategy
Active Comparator group
Description:
The central venous catheterization will be performed by the short axis approach
Treatment:
Device: Short Axis Strategy

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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