Longitudinal or Transverse Orientation of Ultrasound Probe in Minimally Invasive Venous Surgery.

Not Applicable

Completed

• Conditions: Venous Access; Endovenous Procedures; Varicose Veins
• Interventions: Diagnostic Test: Longitudinal; Diagnostic Test: Transverse

• Registration Number: NCT04036734
• Lead Sponsor: National University of Ireland, Galway, Ireland

Brief Summary

Longitudinal ultrasound orientation during central venous cannulation has been suggested by a number of radomised studies to offer superior cannulation rates. This technique may offer a simple, safe and cost-neutral step to improve cannulation rates in the widely performed minimally invasive endovenous intervention.

Detailed Description

Varicose veins are an extremely common disorder and negatively impact on patient quality of life. In recent years minimally invasive venous treatments for varicose veins (MIVT) have emerged as an effective alternative to open surgery. It is associated with a reduction in peri-operative morbidity, recovery time and increased quality of life scores when compared with open surgical stripping4. Furthermore, MIVT is now widely carried out under local anaesthesia.

Typically, MIVT requires cannulation, under ultrasound guidance, of either the great or small saphenous vein in the lower extremity to allow subsequent passage of a venous catheter. This cannulation technique is widely used for venous and arterial cannulation throughout the body. It entails utilising an ultrasound probe in either a longitudinal or transverse orientation (to the target vein) to guide an entry needle into a target vessel. The longitudinal orientation, while unstable, offers better visualisation of the vein when performed accurately. Conversely, the transverse approach is very stable with poorer visualisation of the target vessel. As such, no definitve guidance is available to guide treating physicians as to the optimal orientation with a wide variation among practitioners.

The cannulation process for MIVT is often further challenged by both the small calibre and tendency toward vasospasm of target veins. Failure of cannulation may result in greater rates of conversion to open surgery exposing the patient to the the higher rate of morbidity associated with open surgery. More importantly, repeated cannulation results in significant discomfort and hence a reduction in patient satisfaction.

Longitudinal ultrasound orientation during venous cannulation has been suggested by a number of radomised studies to offer superior cannulation rates of cannulation. This technique may offer a simple, safe and cost-neutral step to improve cannulation rates in the widely performed MIVT.

The authors propose a blinded randomized controlled study to investigate the effects of ultrasound orietation on cannulation rates in MIVT. To test this hypothesis we plan to randomise 100 patients undergoing MIVT to either venous cannulation with transverse or longitudinal orientation of the ultrasound probe.

Study Timeline

• Study Start: 2019-07-24
• Study First Submitted: 2019-07-24
• Study First Submitted QC: 2019-07-25
• Study First Posted: 2019-07-30
• Status Verified: 2020-03
• Primary Completion: 2020-03-01
• Study Completion: 2020-03-01
• Last Update Submitted: 2020-03-25
• Last Update Posted: 2020-03-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 101

Inclusion Criteria

• For minimally invasive venous surgery of the lower limb (Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification score 2 of greater)
• Intervention requiring venous cannulation of axial lower limb vein
• Full consent
• >18 years
• No concomitant deep venous incompetence

Exclusion Criteria

• General anaesthesia

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Longitudinal Ultrasound Orientation	Longitudinal	Longitudinal placement of ultrasound to long axis of target lower limb vein
Transverse Ultrasound Orientation	Transverse	Transverse placement of ultrasound to long axis of target lower limb vein

Primary Outcome Measures

Name	Time	Method
Overall successful Cannulation rate as a percentage	Immediate	Overall successful cannulation of the target axial lower limb vein for endovenous treatment. Successful cannulation will be defined as intraluminal placement of the access cannula in the targeted axial vein.

Secondary Outcome Measures

Name	Time	Method
Time in seconds to cannulation	Immediate	Time from skin puncture to successful placement of access catheter in the target vein
Peri-cannulation pain	Immediate	Pain will be measured using a visual analogue scale of 0-100
Number of cannulation attempts	Immediate	Number of times the skin is pierced in an attempt to cannulate the target vein

Trial Locations

Locations (1)

Saolta University Hospital Group; 🇮🇪 Galway, Ireland