- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04224259
Ultrasound Pre-scan to Reduce Needle Redirection During Right Jugular Vein Cannulation
Utility of Vertical Puncture Technique Assisted by Ultrasound Pre-scan to Reduce Needle Redirection During Right Jugular Vein Cannulation
This study aims to define a simple, safe, and effective ultrasound pre-scan technique for right internal jugular vein (RIJV) cannulation. After placing the patient properly, the operator puts a linear ultrasound probe at the mid neck in short-axis view. With the IVJ in the center of the screen, the operator makes marks at both ends of the transducer (mark A and B), and then rotates the transducer 90 degrees counterclockwise. After finding IJV in long-axis view with transducer vertical to the ground, other two marks are made at both ends of the transducer (mark C and D). After proper preparation, the operator recognizes the cross point made by the imagined lines of marks AB and marks CD (point E). The needle is inserted vertically to the ground at point E.
Inclusion criteria are adult patients receiving general anesthesia in need of central venous cannulation.The primary endpoint is the number of needle redirection, and secondary endpoints include first attempt success rate, artery puncture, complication, number of wire attempt, number of skin insertion, venous access time, catheterization time, and malposition. The hypothesis is that this ultrasound pre-scan method would have a fewer number of needle redirection, a higher first-attempt success rate, as well as less complication, number of redirection.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Ultrasound-guided central venous cannulation has been widely used because of lower technical failure rate and complications, and faster access compared with landmark-guided cannulation. Real-time guidance is more complex to perform and time-consuming in comparison to pre-scan technique. Therefore, real-time guidance should be reserved to specific groups, such as infants, children, or those with anatomical abnormality. However, there's no widely accepted ultrasound pre-scan techniques yet. The aim of this study is to define a simple, safe, and effective ultrasound pre-scan technique for right internal jugular vein (RIJV) cannulation.
Patient position for RIJV cannulation was reviewed in detail. First, 15゚ Trendelenburg tilt significantly increases the diameter of right internal jugular vein. Second, extreme head rotation to the opposite side will increase the overlap percentage between IJV and common carotid artery (CCA), but neutral head position might make the procedure difficult. Neutral head position or small degree (≦15゚) of head rotation was recommended. Third, although shoulder roll is not recommended since it decreases the anterior-posterior diameter of RIJV, 4- to 5cm-high shoulder roll could be used to reduce the overlap if needed10. In conclusion, patients should be positioned by a 15゚ Trendelenburg tilt and 15゚ head rotation to the opposite side without a shoulder roll unless the IJV is anterior to CCA, which was termed as the rule of 15 by the research team.
After placing the patient properly, the operator puts a linear ultrasound probe at the mid neck in short-axis view. With IVJ in the center of the screen, marks at both ends of the transducer (mark A and B) are made. Then the operator rotates transducer 90 degrees counterclockwise. After finding IJV in long-axis view with transducer vertical to the ground, other two marks are made at both ends of the transducer (mark C and D), and transducer and jelly are removed. Then the operator sterilizes the performing field with chlorhexidine without removing the marks. After proper preparation and recognizing the cross point made by the imagined lines of marks AB and marks CD (point E), the operator inserts the needle vertically to the ground at point E.
The aim of this study is to compare the effectiveness and safety between ultrasound pre-scan technique and traditional landmark-guidance. Inclusion criteria are adult patients receiving general anesthesia in need of central venous cannulation. The primary endpoint is the number of needle redirection, and secondary endpoints include first attempt success rate, artery puncture, complication, number of wire attempt, number of skin insertion, venous access time, catheterization time, and malposition. The hypothesis is that the ultrasound pre-scan method would have a fewer number of needle redirection, a higher first-attempt success rate, as well as less complication, number of redirection.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Wei-Chen Chung, Dr.
- Phone Number: +886965562781
- Email: elizabethp215@yahoo.com.tw
Study Contact Backup
- Name: Jui-An Lin, Dr.
- Phone Number: +886970746115
- Email: juian.lin@tmu.edu.tw
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Older than 20 years and younger than 80 years of age
- American Society of Anesthesiologists Physical Status Classification I-III (no immediate life-threatening condition)
- Scheduled for regular surgery
- Receive general anesthesia with endotracheal tube intubation
- In need of central venous catheter placement
Exclusion Criteria:
- Body Mass Index > 35kg/m^2
- Abnormal anatomy of the neck
- Limited range of motion of the neck
- The surgery does not allow right internal jugular vein cannulation or other contraindications for the procedure
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ultrasound pre-scan group
Perform ultrasound pre-scan before central venous cannulation
|
Before cannulation, use ultrasound to mark the position of right internal jugular vein
|
Sham Comparator: landmark guidance group
Use the traditional landmark method to perform central venous cannulation
|
The traditional landmark-guided technique for internal jugular vein cannulation, including recognizing the sternocleidomastoid muscle and palpating the carotid artery
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
number of needle redirection
Time Frame: During the cannulation procedure
|
How many times of the needle being withdrawn and redirected before successfully access internal jugular vein
|
During the cannulation procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
first attempt success rate
Time Frame: During the cannulation procedure
|
successfully access the internal jugular vein at first attempt
|
During the cannulation procedure
|
artery puncture
Time Frame: During the cannulation procedure
|
accidental artery puncture
|
During the cannulation procedure
|
number of wire attempt
Time Frame: During the cannulation procedure
|
how many times of the wire attempts before successful wire insertion to internal jugular vein
|
During the cannulation procedure
|
number of skin insertion
Time Frame: During the cannulation procedure
|
how many different skin insertion sites were tried before successfully access the internal jugular vein
|
During the cannulation procedure
|
venous access time
Time Frame: During the cannulation procedure
|
How long does it take from the first skin insertion to success venous access
|
During the cannulation procedure
|
catheterization time
Time Frame: During the cannulation procedure
|
How long does it take from the first skin insertion to successful catheter cannulation
|
During the cannulation procedure
|
malposition
Time Frame: During the cannulation procedure
|
the catheter misplaced to wrong sites (e.g.
artery, subcutaneous)
|
During the cannulation procedure
|
presence of hematoma
Time Frame: immediately at the end of procedure, evaluated by clinical signs and ultrasound image
|
a different and blinded investigator reviewed the post-procedure ultrasound image to determine whether there is hematoma after the procedure
|
immediately at the end of procedure, evaluated by clinical signs and ultrasound image
|
other complication
Time Frame: during the procedure, and 1 day after the procedure
|
Other complications related to the procedure, such as pneumothorax
|
during the procedure, and 1 day after the procedure
|
Collaborators and Investigators
Investigators
- Study Chair: Jui-An Lin, Dr., Doctor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- N201803005
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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