Central Venous Catheter Insertion Techniques

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

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

Study Overview

• Status: Completed
• Conditions: Catheterization, Central Venous
• Intervention / Treatment: Procedure: Anatomical Landmark technique; Procedure: Ultrasound-guided pre location technique; Procedure: Ultrasound-guided real-time technique

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.

• Study Type: Interventional
• Enrollment (Actual): 201
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Sindh
    • Karachi, Sindh, Pakistan, 74800
      • Aga Khan University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ALT	Procedure: Anatomical Landmark technique; anatomical landmarks (sternocleidomastoid muscles, sternal notch, cricoid cartilage, carotid artery and clavicle) will be palpated. A 3cc syringe with 21 gauge needle (locator) will be used first to locate IJV at the apex of the triangle formed by the two heads of the sternocleidomastoid muscle. After successful location, an introducer needle of 18 gauge, attached with a 5 ml syringe, will be inserted at the same point. The introducer needle will be directed towards the ipsilateral nipple at an angle of 20-30° with the skin
Active Comparator: USG-Pre	Procedure: Ultrasound-guided pre location technique; In Group Ultrasound-guided pre location technique, venipuncture site will be determined using ultrasound probe which will be then removed and locator needle of 21 gauge will be used first to confirm IJV location. The cannulation or venipuncture will be performed at the marked point of locator needle by the use of 18 gauge introducer needle.
Active Comparator: USG -RT	Procedure: Ultrasound-guided real-time technique; In Group Ultrasound-guided real-time technique, cannulation or venipuncture will be performed under real-time imaging using 18 gauge needle i-e ultrasound will be used for prelocation and puncturing of IJV and locator needle will not be used

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Success Rate	Success rate will be measured according to the number of attempts. The cannulation of right Internal Jugular Vein within the first three attempts.	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time duration for each technique	Measurment of time in minutes	Day 1
Incidence of Complications	Look for carotid puncture, haematoma formation , pneumothorax	Day 1

Collaborators and Investigators

• Sponsor: Aga Khan University Hospital, Pakistan

Publications and helpful links

General Publications

• 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.
• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2019
• Primary Completion (Actual): April 1, 2021
• Study Completion (Actual): July 4, 2021

Study Registration Dates

• First Submitted: May 19, 2022
• First Submitted That Met QC Criteria: May 23, 2022
• First Posted (Actual): May 24, 2022

Study Record Updates

• Last Update Posted (Actual): August 1, 2023
• Last Update Submitted That Met QC Criteria: July 30, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Ultrasound; Cardiac Surgery; Central Venous Catheter; Anatomical Landmark
• Other Study ID Numbers: 3488-Ane-ERC-15

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No