To Compare the In-plane and Out of Plane Ultrasound Guided Approach for Internal Jugular Vein Cannulation in the Patients Undergoing Elective Cardiac Surgery.

NCT04840810 | Completed DMC

• 1 other identifier: AgaKhanUH
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

The insertion of central venous catheters (CVCs) has become an integral part of management of a critically ill patient. Access to the central vein may be required for the administration of hyper osmotic or vasoactive compounds, parenteral nutrition, and rapid infusion of large volumes of fluid or for the continuous or intermittent monitoring of biochemical or physiological parameters. Central venous catheter insertion is also indicated when the insertion of a peripheral line is not possible. Traditionally, CVC insertions have been performed using the landmark technique. Considering the number of CVCs being inserted every day, this can amount to a large number of complications. Efforts to minimize and prevent the occurrence of complications should be a routine component of quality improvement programs. There is an increasing body of evidence supporting the use of ultrasound guidance for CVC placement. This makes the strong rationale to conduct this research thus the aim of this study is to evaluate the real benefits i.e outcome of Long versus Short Axis ultrasound guided approach for internal jugular vein cannulation in the patient for elective cardiac surgery as central venous cannulation (CVC).

Conditions

Catheterization, Central Venous; Ultrasonography; Cardiac Surgical Procedures

Outcome Measures

Primary Outcomes (2)

• First pass success Rate

  Recoded in percentage. Needle successfully inserted into the internal jugular vein and there is no need of Readjustment

  immediately after end of procedure

• Duration of procedure

  Recorded in seconds

  Intraoperative (after skin prick to ultrasound confirmation of presence of guide wire within internal jugular vein)

Secondary Outcomes (1)

• Unintentional carotid puncture

  immediately after completion of procedure

Study Arms (2)

Out of plane/ short axis central venous cannulation

ACTIVE COMPARATOR

In a short-axis view, the image plane is perpendicular to the course of the vessel and to the needle (needle is "out of plane"). The vessel appears as an anechoic circle on the screen of ultrasound with the needle visualized as a hyperechoic point in cross-section. The central venous cannulation was done in out of plane axis.

Procedure: In-plane Axis

In-plane/long axis central venous cannulation

ACTIVE COMPARATOR

In a long-axis view, the image plane is parallel to the course of the vessel (needle is "in-plane"). The image shows the course of the vessel across the screen and the shaft and point of the needle as it is advanced. The central venous cannulation was done in in-plane axis.

Procedure: Out of plane Axis

Interventions

In-plane Axis PROCEDURE

In a long-axis view, the image plane is parallel to the course of the vessel (needle is "in-plane"). The image shows the course of the vessel across the screen and the shaft and point of the needle as it is advanced. The central venous cannulation was done in in-plane axis.

Out of plane/ short axis central venous cannulation

Out of plane Axis PROCEDURE

In a short-axis view, the image plane is perpendicular to the course of the vessel and to the needle (needle is "out of plane"). The vessel appears as an anechoic circle on the screen of ultrasound with the needle visualized as a hyperechoic point in cross-section. The central venous cannulation was done in out of plane axis.

In-plane/long axis central venous cannulation

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients admitted for elective cardiac surgery.
• Age between 18 - 75 years.

You may not qualify if:

• BMI more than 30.
• Haemodynamically unstable.
• Patient with abnormal coagulation profile(INR\>1.5 or Platelet counts\<50,000).
• Patient with a short neck.
• Patient with carotid Atherosclerosis proven on ultrasound.

Sponsors & Collaborators

• Aga Khan University Hospital, Pakistan: lead

Study Sites (1)

Aga khan university Hospital

Karachi, Sindh, Pakistan

Location

Related Publications (3)

• Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007 Jun;33(6):1055-9. doi: 10.1007/s00134-007-0560-z. Epub 2007 Mar 7.

  PMID: 17342519 BACKGROUND

• Jefferson P, Ogbue MN, Hamilton KE, Ball DR. A survey of the use of portable ultrasound for central vein cannulation on critical care units in the UK. Anaesthesia. 2002 Apr;57(4):365-8. doi: 10.1046/j.1365-2044.2002.02319.x.

  PMID: 11939995 BACKGROUND

• Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996 Dec;24(12):2053-8. doi: 10.1097/00003246-199612000-00020.

  PMID: 8968276 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Staff Medical officer AKUH

Study Record Dates

• First Submitted: April 8, 2021
• First Posted: April 12, 2021
• Study Start: January 1, 2019
• Primary Completion: March 30, 2019
• Study Completion: April 2, 2019
• Last Updated: April 13, 2021

Record last verified: 2021-04

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)