Cardiac Surgical Procedures, Catheterization, Central Venous, Ultrasonography
Conditions
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).
Detailed description
OBJECTIVE: To compare the in plane and out of plane ultrasound guided approach for internal jugular vein cannulation in the patients undergoing elective cardiac surgery. Ultrasound-guided central vein cannulation has many advantages, giving the operator the possibility of choosing the most appropriate and safest venous access on the basis of ultrasound assessment, performing a 100% safe insertion, ruling out malposition or pleuropulmonary damages, during and after the procedure. 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).
Interventions
PROCEDUREIn-plane Axis
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.
PROCEDUREOut of plane Axis
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.
Sponsors
Aga Khan University Hospital, Pakistan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients admitted for elective cardiac surgery. * Age between 18 - 75 years.
Exclusion criteria
* 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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First pass success Rate | immediately after end of procedure | Recoded in percentage. Needle successfully inserted into the internal jugular vein and there is no need of Readjustment |
| Duration of procedure | Intraoperative (after skin prick to ultrasound confirmation of presence of guide wire within internal jugular vein) | Recorded in seconds |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Unintentional carotid puncture | immediately after completion of procedure | Recorded in percentage |
Countries
Pakistan
Outcome results
None listed