COMPARISON OF CLASSICAL AND SYRINGE-FREE TECHNIQUES IN ULTRASOUND-GUIDED CENTRAL JUGULAR VENOUS CATHETERIZATION (syringe-free)

During central venous catheterization, both in-plane and out-of-plane techniques can be used. In the in-plane technique, the entire needle can be visualized with ultrasound. In the in-plane technique with a linear probe, the vessel and needle are visualized longitudinally. In the syringe technique, a guide needle attached to a syringe is first inserted into the vein and blood is aspirated, then the catheter is placed through a wire sent into the vein via the needle. This procedure is performed under ultrasound guidance, visualizing the vessels, guide wire, and needle.

In the syringe-less technique, the guide wire is placed inside the needle and sent directly into the vein. In this technique, there is no need to draw blood into the syringe to confirm that it is in the vein.

The aim of our study is to compare the two ultrasound-guided techniques in terms of procedure time, number of attempts, and complication rates. We expect the syringe-less technique to have a shorter procedure time, fewer attempts, and a lower complication rate.

Study Overview

• Status: Not yet recruiting
• Conditions: Central Venous Catheters/Standards; Ultrasonography/Methods; Ultrasonography/Standards
• Intervention / Treatment: Procedure: out-of-plane technique; Procedure: in-plane technique

Detailed Description

Today, central venous catheters are frequently placed in operating rooms, intensive care units, and emergency departments for reasons such as intravenous fluid and drug infusion, measurement of cardiac parameters, inability to find a vein, total parenteral nutrition, septic shock, and similar critical illnesses. Performing central venous catheterization under ultrasound guidance has reduced the number of attempts, procedure time, and intra-procedure complications. International guidelines recommend the standard use of ultrasound in central venous catheterization. During ultrasound-guided central venous catheter placement, the vessels and needle can be simultaneously visualized. Both in-plane and out-of-plane techniques can be used during the catheterization procedure. In the in-plane technique, the entire needle is visualized by ultrasound. In the in-plane technique with a linear probe, the vessel and needle are visualized longitudinally. In the syringe technique, a guide needle attached to a syringe is first inserted into the vein to aspirate blood, and then the catheter is placed through a wire sent into the vein via the needle. This procedure is performed under ultrasound guidance, visualizing the vessels, guide wire, and needle.

In the syringe technique, a guide needle attached to a syringe is first inserted into the vein to aspirate blood, and then the catheter is placed through a wire sent into the vein via the needle. In the syringe-free technique, a guide wire is placed inside the needle and directly inserted into the vein. In this technique, there is no need to draw blood into a syringe to confirm that the needle is in the vein.

The aim of our study is to compare two ultrasound-guided techniques in terms of procedure time, number of attempts, and complication rates. We expect the syringe-free technique to have a shorter procedure time, fewer attempts, and a lower complication rate.

Materials and Methods Section:

The study was designed as a prospective, randomized, and single-blind study. Patients aged 18-85 years with an indication for central venous catheterization will be included in the study. Informed consent will be obtained from patients who will undergo surgery under general anesthesia before the anesthesia procedure.

Patients included in the study will be divided into two groups using computer-assisted randomization.

Patients in the first group will undergo central catheterization of the jugular vein using the Seldinger method (first inserting a guide wire and then inserting the catheter) with ultrasound guidance using an out-of-plane technique.

In the second group of patients, central jugular vein catheterization will be performed using the Seldinger method (with a guide wire) with in-plane technique (longitudinal visualization of the entire needle and vessel) under ultrasound guidance. A linear ultrasound probe will be used in both groups of patients during the procedure. The number of needle insertions, needle placements, number of attempts, and procedure time will be recorded and compared for both groups. In addition, rare complications such as bleeding, hemothorax, pneumothorax, hematoma, and carotid artery injury will be recorded. The ease of the procedure will be scored by the practitioner on a scale of 0 to 10 (0: most difficult, 10: easiest). The appearance of the needle, vessels, guide wire, and catheter on ultrasound will also be scored and recorded on a scale of 1 to 5 (very difficult: 1, difficult: 2, moderate: 3, easy appearance: 4, excellent: 5).

The recorded data will be compared between the two groups.

Inclusion Criteria:

Patients aged 18-85 years with indications for central venous catheterization in the operating room.

Exclusion Criteria:

Morbidly obese patients (BMI >40) Patients with severe coagulopathy Patients with severe neck deformity Patients with skin deformity or infection at the catheterization site Patients with congenital anomalies in the central veins

Sample Selection:

Considering previous studies on this subject, a total of 80 patients in both groups are needed to shorten the procedure time by 30%. Considering patients who may be excluded from the study, a total of 90 patients were planned to be included (α: 0.05, power 90%).

Statistical Method to be Used:

Continuous quantitative data will be presented as number, mean ± standard deviation. Qualitative variables will be expressed as median, 25th and 75th percentiles. Continuous variables with independent measurements and a normal distribution will be analyzed using the T-test. For data that do not show a normal distribution, the Mann-Whitney test will be applied. Chi-square tests will be applied to categorical data, and p <0.05 will be considered statistically significant.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ali Eman; Phone Number: medical doctor +905325152816; Email: dralieman02@gmail.com
• Study Contact Backup: Name: Onur Balaban, medical doctor; Phone Number: +905327000691

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 18-85 years who have an indication for central venous catheterization in the operating room.

Exclusion Criteria:

• Morbidly obese patients (body mass index >40)
• Those with severe coagulopathy
• Severe neck deformity
• Skin deformity or infection at the catheterization site
• Those with congenital anomalies in the central veins

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: with a syringe; Central catheterization of the jugular vein will be performed using the Seldinger method (first inserting a guide wire, then placing the catheter over it) with ultrasound guidance and an out-of-plane technique. A guide needle attached to a syringe will be inserted into the vein to aspirate blood, and then a catheter will be placed over the wire sent into the vein through the needle. This procedure will be performed under ultrasound guidance, visualizing the veins, guide wire, and needle.	Procedure: out-of-plane technique; ultrasound-guided out-of-plane technique for central venous catheterization
Active Comparator: syringe-free technique; In the syringe-free technique, a guide wire will be placed inside the needle and sent directly into the vein. In this technique, central jugular vein catheterization will be performed using the Seldinger method (using a guide wire) with an in-plane approach (visualizing the entire needle and vein longitudinally). There is no need to draw blood into a syringe to confirm that the needle is in the vein.	Procedure: in-plane technique; In the syringe-free technique, a guide wire is placed inside the needle and sent directly into the vein. In this technique, there is no need to draw blood into the syringe to confirm its presence in the vein. Using ultrasound-guided in-plane technique (with the entire needle and vein visualized longitudinally), central catheterization of the jugular vein will be performed using the Seldinger method (with a guide wire).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
processing time	The technique to be used will be determined according to the randomization performed. The procedure time will begin at the moment of the first needle insertion (syringe or catheter needle) after skin cleansing and will end at the placement of the jugular catheter without suturing.	The procedure time is expected to be 30% shorter with the syringe-free technique. Catheter insertion is expected to take around 120 seconds.

Collaborators and Investigators

• Sponsor: ALİEMAN

Publications and helpful links

General Publications

• 5. Balaban, O., Turgut, M., & Aydın, T. (2020). Ultrasound-guided supraclavicular brachiocephalic vein catheterization in children: Syringe-free in-plane technique with micro-convex probe. The journal of vascular access, 21(2), 241-245. https://doi.org/10.1177/1129729819867221

Study record dates

Study Major Dates

• Study Start (Estimated): March 30, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: April 17, 2026
• First Submitted That Met QC Criteria: April 17, 2026
• First Posted (Actual): April 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 17, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: central venous catheterization with and without syringe
• Other Study ID Numbers: balaban jugular catheter

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Patient demographic data Study protocol Statistical analysis data
• IPD Sharing Time Frame: Sonuçların yayınlanmasından 3 ay sonra başlayıp 3 yıl sonra sona eren dönem
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

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