Comparison of Ultrasound-Guided Internal Jugular Vein Cannulation in Supine and Lateral Position:A Prospective Randomised Controlled Trial

Patients are typically positioned supine when central venous catheters are inserted.However, when a patient is in the lateral position for various surgeries (like VATs, thoracotomies,nephrectomies, orthopedic surgeries) and urgent central venous access is required, catheter placementwith the patient in the lateral position may be necessary. It may be necessary in the operating room when the patient is in the lateral position, has significant blood loss, and requires urgent CVC insertion for the initiation of vasopressor drugs. Changing patients in the supine position for CVC insertion could waste time, cause hemodynamic instability, hinder the sterility of surgical drapes or positioning, and put airways at risk, particularly if they are under general anesthesia. To our knowledge, CVC insertion in lateral

position has not been studied thoroughly. There is limited evidence comparing the safety, efficacy, and success rates of IJV cannulation in the lateral position versus the standard supine position. Consequently,we intend to compare USG-guided IJV cannulation in the supine and lateral positions.

This study addresses a gap in clinical knowledge regarding central venous access in alternative patient positions. Results may influence

guidelines and improve patient safety and procedural success in critical care and surgical settings where supine positioning is contraindicated or impractical.

Population- Patients aged more or equal t o 18 years, ASA status 1-3,scheduled for surgery in lateral position and requiring CVC

Intervention- Ultrasound guided IJV cannulation in lateral position

Comparator-Ultrasound guided IJV cannulation in supine position

Outcome- First attempt success rate

Timeline- 12 months

Research Question

"Is the first-attempt success rate of ultrasound-guided internal jugular vein cannulation in the lateral position non-inferior to the supine position among adult patients requiring central venous access?"

Aims and Objectives

Comparison of ultrasound-guided internal jugular vein cannulation in supine and lateral

position

• Primary Objective-

To compare the first attempt success rate of IJV cannulation in supine and

lateral position

Secondary Objectives-

1. To compare the access time of IJV cannulation in the two positions.

2 . To compare the guide wire insertion time of IJV cannulation i n the two

positions.

3 . To compare the catheterization time of IJV cannulation in the two positions.

4. To compare the number of attempts taken for IJV cannulation in the two

positions.

5. To compare the total success rate of IJV cannulation in the two positions.

6. To compare the complications of IJV cannulation i n the two positions.

7. Operator satisfaction using likert scale 1to 5

8.Operator experience in US guided IJV cannulation will be noted

Study Participants:

Inclusion criteria:

Age equal to or more than 18 years

Patients scheduled for surgery in lateral position, requiring Central venous cathetrisation

Exclusion criteria:

Patients with previous surgery at the site of insertion

Infection at the site of insertion

Patients with coagulopathy or on anticoagulation therapy.

Internal jugular vein could not be visualized or appear thrombosed during initial screenin

Sample Size Calculation:

Julie Leung et al have reported that IJV cannulation success rate was 82  percent in supine position. Assuming an alpha = 0.05 (one-sided for non-inferiority), power 80 percent and non-inferiority margin  20 percent (procedural outcomes) and 10 percent contingency for dropouts, the sample size is calculated as 52 patients per group