None listed
Conditions
Brief summary
This is a single centre, prospective, uncontrolled research involving patients requiring internal jugular vein catheterization for their optimal management in RIPAS Hospital. All patients requiring IJV catheterization are included in the study. Consent will taken from the patient or next of kin. Doctors with minimum one year experience in ultrasound guided IJV cannulation are given training by detailed explanation and observation of cannulation using new technique twice before allowing to do the IJV catheterization using new anteroposterior short axis in-plane ultrasound guided technique. Access time from starting of skin puncture to successful venous puncture will be measured using stop watch in seconds. Primary outcome measures are aspiration of venous blood in to syringe and number of attempts. Success rate is number of patients in whom able to pass guide wire successfully as confirmed by ultrasound. Any complications due to this technique are recorded.
Interventions
: Internal jugular vein (IJV) catheterization is done using standard Seldinger technique. Cannulation, that is puncturing the IJV with needle, is done under ultrasound guidance Conventional practice is to keep ultrasound probe across IJV on the anterior aspect of neck with marker facing medially to obtain short axis view and cannulation is done using out of plane technique where needle tip cannot be seen. In this new technique, short axis view of IJV is obtained by placing the ultrasound probe
: Internal jugular vein (IJV) catheterization is done using standard Seldinger technique. Cannulation, that is puncturing the IJV with needle, is done under ultrasound guidance Conventional practice is to keep ultrasound probe across IJV on the anterior aspect of neck with marker facing medially to obtain short axis view and cannulation is done using out of plane technique where needle tip cannot be seen. In this new technique, short axis view of IJV is obtained by placing the ultrasound probe perpendicularly by the side of the neck anteroposteriorly with the marker facing anteriorly. Ultrasound machine shows cross sectional image of IJV and carotid artery where lateral aspect of neck is on the top of the image and anterior aspect of neck is to the left of the image. Then, the approximate distance between center of the IJV and lateral aspect of neck, that is top of the image, is calculated. This distance is used to mark the skin on the anterior aspect of neck from ultrasound probe. This is the needle entry point. The needle is passed, as in in-plane technique, perpendicular to the ultrasound beam and parallel to the ultrasound probe from the calculated entry point on the anterior aspect of the neck towards the center of the IJV. Needle can be seen moving towards IJV from the left of the image on the screen. The needle can be directed upwards on the screen by directing the needle laterally towards the probe and downwards by directing the needle medially away from the probe for finer adjustments. Once needle punctures the IJV, free aspiration of dark venous blood confirms the needle tip position. As needle entry is perpendicular, to direct the guide wire towards heart, tilt the needle tip towards foot. After threading the guide wire confirm its position using ultrasound before dilatation and catheterization. Entire procedure is done under standard aseptic precaution by doctors with at least one year experience in ultrasound guided IJV cannulation. Chest X-ray is taken after the procedure to confirm the position of the catheter.
Sponsors
Ganapathi Aithal
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients who require IJV catheterization
Exclusion criteria
Refusal to participate in this study, previous surgery at the site of insertion, infection at the site of insertion, clotting abnormalities, presence of thrombus within the jugular vein and abnormal anatomy.
Outcome results
None listed