An interventional study of Short axis out of plane and Anteroposterior short axis in plane in Central Venous Catheterization, sponsored by Abant Izzet Baysal University. Status unknown at 2 sites in Turkey. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2023-02-15.
Sponsored by Abant Izzet Baysal University · Not applicable, Interventional, and Other
Ultrasound guidance in central venous catheterization has become the standard for clinical practice. Many approaches have been described in ultrasound guided catheterization procedures. The aim of this study is to compare the classical short axis out of plane (SAX-OOP) approach and the new anteroposterior short axis in plane (APSAX-IP approach in central jugular venous catheterization. The study was planned as prospective randomized and controlled. One hundred patients were planned to be included in this study.
Patients will be divided into two groups: Central jugular vein catheterization will be performed with the short axis out of plane group (ultrasound transducer will be positioned classically from medial to lateral in the neck) and anteroposterior short axis in plane group (ultrasound transducer will be positioned laterally from anterior to posterior on the neck). The two groups will be compared in terms of number of puncture attempts, duration of the procedure, ultrasound scan time before the procedure, number of needle redirection, overall success rate, complications, ease of catheterization and ultrasound visibility.
Central venous catheterization is a method frequently used in intensive care patients and patients to be operated. With classical methods, this central venous vascular access procedure in the landmark method can be performed or it can be successfully performed under ultrasound guidance.
Ultrasound-guided central venous catheterization is a safer and recommended approach. During venous catheterization with ultrasound the vein and its neighborhood can be easily visualized and it can be followed while the needle is directed to the target in vein puncture. Undesirable complications (hematoma, pneumothorax, arterial puncture) also decrease with the decrease in the number of punctures under ultrasound guidance. Ultrasound guided central catheterization which facilitates safer and faster procedures constitutes an important area for patient care. With the development of technology and the increase in accessibility it constitutes an important and useful area in the interventions made with ultrasound. The internal jugular vein is a frequently chosen central venous structure.
Many ultrasound-guided imaging and intervention methods have been described for catheterization of the internal jugular vein with the Seldinger method. These are described as longitudinal (long axis), transverse (short axis) and oblique methods for imaging and probe position. The image taken with the position of the needle relative to the ultrasound probe is described as in plane and out of plane.
Each method may have advantages over each other and can be preferred according to the patient's condition and the experience of the practitioner. Successful and safe catheterizations can be performed in the internal jugular vein with the short axis out-of-plane (SAX-OOP) method which is especially used in adults . Short axis out of plane is a successful method that can almost be called a classic that comes to mind first. Compared to other needle imaging methods out of plane tracking of the needle (as a point) seems to be a disadvantage in the user's imaging compared to the in-plane tracking method. Of course, it is easier and faster to capture the short axis when imaging the venous structure as long axis or short axis with ultrasound.
The " Anteroposterior short axis in plane" (APSAX-IP) technique is first reported by Aithal G. et al. in 2019. The use of both short axis and in-plane approaches has been described.The difference of the anteroposterior short axis in plane (APSAX-IP ) technique from the classical short axis out of plane (SAX-OOP) technique is that the location of the ultrasound is lateral to the neck, the needle is about 2-3 cm away from the ultrasound, the entry area from the skin, the needle is advanced subcutaneously in the anteroposterior direction, not medially, and the needle is not as a point in ultrasound that can be viewed longitudinally. It is thought that the APSAX-IP method has advantages such as easier follow-up of the needle, easier monitoring of the progression of the needle without damaging the posterior wall by seeing a large anterior posterior diameter of the vessel. It is stated that the APSAX-IP method will be more ergonomic in patients with short neck anatomy, obese and pediatric patients due to the location of the ultrasound probe. One method may be preferred over the other in patients. Although the definition of the method has been made, it has not been compared with any catheterization method. The aim of our study is to compare the classical SAX-OOP method and the newly defined APSAX-IP method in terms of difficulty, needle puncture time, needle procedure time and complications.
Abant Izzet Baysal University is the lead sponsor of 242 studies on the registry; 64 are open to participants now.
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A linear ultrasound probe will be utilized to place the central catheter into the jugular vein with a short axis out of the plane method
Procedure: Short axis out of plane
A linear ultrasound probe will be utilized to place the central catheter into the jugular vein with an anteroposterior short axis in-plane method
Procedure: Anteroposterior short axis in plane
A standard 20 cm (adult-size) 3-port central catheter will be placed to the indicated patients by using standard Seldinger technique (with the assist of a guide wire) under ultrasound guidance short axis visualisation out of plane approaches.
Also known as: Ultrasound guided central venous catheterization with short axis out of plane approach
A standard 20 cm (adult-size) 3-port central catheter will be placed to the indicated patients by using standard Seldinger technique (with the assist of a guide wire) under ultrasound guidance anteroposterior short axis visualisation in plane approaches.
Also known as: Ultrasound guided central venous catheterization with anteroposterior short axis in plane approach
Number of puncture attempts
Number of needle insertions to the catheterization region for placing a catheter
Time frame: From the 1st second through withdrawal of the needle, up to 3 minutes
Cannulation procedural time
Duration of the whole cannulation procedure
Time frame: During the procedure, starting from the 1st second through placement of the catheter; up to 3 minutes
Catheterization procedural time
Duration of the whole catheterization procedure
Time frame: During the procedure, starting from the 1st second through placement of the catheter; up to 3 minutes
Number of needle redirections
Redirections of the needle towards the vessel
Time frame: During the whole cannulation procedure
Success rate
Correct placement of the catheter over the guidewire after central vein puncture
Time frame: Through catheterizations completion, an average of 4 months
Success rate at first attempt
Success rate at first attempt of the procedures in each group
Time frame: Through study completion, an average of 4 months
Complications
Rate of complications that occur during catheterization procedure
Time frame: Through study completion, an average of 4 months ]
Vessel visualization
Visualization of the vessels in dynamic ultrasound images
Time frame: Throughout the procedure; up to 3 minutes
Needle visualization
Visualization of the needle in dynamic ultrasound images
Time frame: Throughout the procedure; up to 3 minutes
Guide-wire visualization
Visualization of the guide-wire in dynamic ultrasound images
Time frame: Throughout the procedure; up to 3 minute
Ease of the catheterization process
A subjective score assigned by the operator on a scale with a minimum value of 0 and maximum value of 10. Higher scores mean a better outcome
Time frame: Throughout the procedure; up to 3 minutes
Ultrasound time
The duration of pre-procedural ultrasound scanning
Time frame: Throughout the pre-procedural ultrasonography; up to 10 minutes
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Abant Izzet Baysal University