Central Venous Catheterization
Conditions
Keywords
axillary vein, sub clavian vein, comparison of strategies
Brief summary
The main objective of this study is to compare the rate of successful establishment of a central venous catheter in the first two attempts of ultrasound-guided puncture between two techniques: (1) a subclavian technique versus (2) an axillary technique.
Detailed description
The secondary objectives of this study are to compare the following between the two techniques: * the success rate of the establishment of a central venous catheter * the success rate of establishment of a central venous catheter at the first attempt at venipuncture * for non-failures (eg, a catheter is placed in the first four trys), time to cannulation * the presence / absence of the following complications: * arterial puncture (yes / no) * pneumothorax (yes / no) * hemothorax (yes / no) * hematoma (yes / no) * nerve injury (yes / no) * aberrant course (yes / no) The reasons catheter placement failures will also be described.
Interventions
PROCEDUREAxillary strategy
The first two attempts at central venous catheterization will be performed via the distal approach (axillary vein). The third and fourth attempts at central venous catheterization will be performed by the medial approach (subclavian vein). The same puncture material/devices will be used in both arms of the study.
PROCEDURESubclavian strategy
The first two attempts at central venous catheterization will be performed by the medial approach (subclavian vein). The third and fourth attempts at central venous catheterization will be performed by the distal approach (axillary vein). The same puncture material/devices will be used in both arms of the study.
Sponsors
Centre Hospitalier Universitaire de Nīmes
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* The patient must have given his/her informed and signed consent * The patient must be insured or beneficiary of a health insurance plan * The patient is available for 24 hours of follow-up * Patient requiring the establishment of a central venous catheter
Exclusion criteria
* The patient is in an exclusion period determined by a previous study * The patient is under judicial protection, under tutorship or curatorship * The patient refuses to sign the consent * It is impossible to correctly inform the patient * The patient is pregnant, parturient, or breastfeeding * Patient has a body mass index \< 15 or \> 40 * Congenital or acquired anatomical deformity (radiation therapy, trauma, surgery) of the axillary and/or subclavian regions * Bleeding disorder (platelets \< 50,000, prothrombine \< 50%, activated cephaline time \> 2 times the control value) * Severe hypoxemia defined by a ratio PaO2 / FIO2 \< 100 * Infection of the puncture area * Known thrombosis of the subclavian or axillary veins * Scheduled length of hospitalization less than 24 hours * Agitated or non-cooperative patient * The patient has already been included in this study * subclavian and axillary veins are not simultaneously echogenic on one or both sides (left and right).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Central venous catheter established within first 2 puncture attempts | approximately 3 minutes | yes/no |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Establishment of a central venous catheter | approximately 3 minutes | yes/no |
| Central venous catheter established upon first punction attempt | approximately 3 minutes | yes/no |
| The time necessary for the establishment of a central venous catheter | approximately 3 minutes | For non-failures (ie establishment of a central venous catheter within 4 puncture attempts), the number of minutes necessary for the establishment of a central venous catheter |
| presence/absence of complications | Day 1 | arterial puncture (yes / no), pneumothorax (yes / no), hemothorax (yes / no), hematoma (yes / no), nerve injury (yes / no), aberrant course (yes / no) |
Countries
France
Outcome results
None listed