Long-versus Short-Axis Ultrasound Guidance for Subclavian Vein Cannulation

Not Applicable

Completed

• Conditions: Vascular Access Complication; Perioperative/Postoperative Complications
• Interventions: Device: Long Axis strategy; Device: Short Axis Strategy

• Registration Number: NCT01927185
• Lead Sponsor: Azienda Ospedaliero-Universitaria di Parma

Brief Summary

Central venous catheterization is commonly applied in patients undergoing cardiac surgery. The subclavian vein has lower risk of infection and provides more patients comfort. However central venous catheterization may results in complications such as pneumothorax, hemothorax or arterial puncture. It has been suggested that ultrasound (US) guidance could improve the success rate, reduce the number of needle passes and decrease complications. Two different real-time 2-dimensional US techniques can be employed in the insertion of central venous catheters. The first technique involves real-time US-guided cannulation of subclavian vein using a long axis/in-plane approach. The second one involves real-time US-guided using a short axis/out-off-plane approach. However to date no studies have compared their efficacy and safety. The purpose of this study was to compare the US-guided long-axis versus short-axis approach for the SCV catheterization in adult critical care patients.

Detailed Description

The two techniques used for vessel visualization are far different:

The Short-Axis (SA) approach attempts to view the vessel in cross-section while venous access is obtained. The strength of the SA approach is that the vein is centered under the transducer and that the midpoint of the transducer becomes a reference point for the insertion of the needle, and that at the same time is possible to visualize SC artery and the pleural line. SA approach is easy to learn by novice sonologists.

The Long-Axis (LA) approach employs a technique that views the length of the vessel during cannulation.For this reason, with LA approach is possible to visualize the needle advance during the entire procedure from the soft tissues until the lumen of the vein, but SC artery and pleural line are not visualized in the same scan. For LA approach, practice is required to keep the needle precisely within the image and care must be taken to avoid the probe inadvertently moving away from the target structure.

Study Timeline

• Study Start: 2013-06
• Study First Submitted: 2013-08-20
• Study First Submitted QC: 2013-08-21
• Study First Posted: 2013-08-22
• Primary Completion: 2016-03
• Study Completion: 2016-03
• Status Verified: 2017-01
• Last Update Submitted: 2017-01-24
• Last Update Posted: 2017-01-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 190

Inclusion Criteria

• aged =>18 years
• patients who needed central venous catheter for clinical reasons

Exclusion Criteria

• aged <18a years

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Long Axis strategy	Long Axis strategy	The central venous catheterization will be performed by the long axis approach
Short Axis Strategy	Short Axis Strategy	The central venous catheterization will be performed by the short axis approach

Primary Outcome Measures

Name	Time	Method
Success rate	up to 4 hours

Secondary Outcome Measures

Name	Time	Method
Complication rate	Hours: 0-6-12-24	Pneumothorax, Haemothorax, Hydrothorax, Artery puncture, Hematoma, Malpositions
Central line-associated blood stream infection	days 0-21
Access Time	Hours: 0,1
Number of attempts	hours: 0-2	Overall number of skin penetration and number of withdraws and redirections of the needle

Trial Locations

Locations (1)

Cardiac Surgery. Azienda Ospedaliero Universitaria di Parma; 🇮🇹 Parma, Italy