Comparative study of efficacy and safety of Ultrasound guided Supraclavicular subclavian vein cannulation versus Internal jugular vein cannulation in Adult patients posted for surgery under General anaesthesia .

METHODS:

After institutional ethical committee approval, the study will be registered in clinical trial registry of India (CTRI). Pre anaesthetic checkup of all patients will be done prior to general anaesthesia. Consent for participation in study will be obtained from patients. Patient or relatives will be explained about procedure.

·      Pre-operative parameters such as heart rate, blood pressure and oxygen saturation will be recorded. Then IV line will be secured with 20G needle & IV Fluids will be started.Generalanaesthesia will be administered using drugs as per institutional protocols and patient’s general condition, airway will be secured with endotracheal tube.

·      The patient will be positioned supine, with arms adducted and the neck rotated to the contralateral side. An ultrasound (USG) machine (Samsung HS 40)and 5–12 MHz linear transducer probe will be used for the procedure

·      Before initiating the procedure, a preliminary ultrasound scan will be conducted in all patients using gentle transducer pressure. The internal jugular vein (IJV) and supra-clavicular subclavian vein (SCV) calibers will be assessed.

·      With all aseptic precautions, the cannulation site is prepared and draped.

·      In the subclavian vein (SCV)group, Patients were placed in supine position with head turned to the left side. Subclavian vein is best found in long axis in supraclavicular fossa before it joins internal jugular vein to become right innominate vein/ brachiocephalic vein. After visualization the needle is inserted with “in plain” approach.  After successful aspiration of blood,the guidewire will be advanced, and its position will be confirmed on ultrasound. Cannulation will be done using the Seldinger technique, and the catheter will be secured in supraclavicular fossa& sterile dressing will be applied.

 ·      In the internal jugular vein (IJV) group, ultrasound (USG) transducer will be placed transversely (short-axis view) on the patient’s neck, lateral to the cricoid cartilage. The internal jugular vein (IJV) is identified as a compressible, non-pulsatile structure. After centering the right internal jugular vein (IJV) on the ultrasound screen. Using an out-of-plane technique, the vein will be punctured and after successful aspiration of blood,A guidewirewill be introduced, and its position within the internal jugular vein (IJV) will be confirmed using a short-axis USG view. A central venous catheter (CVC) will be inserted using the Seldinger technique. The catheter will be secured and sterile dressing will be applied.