Comparative Evaluation of Ultrasound Guided Supraclavicular and Infraclavicular Subclavian Venous Catheterizations in Adult Patients Undergoing Major Surgeries

Post Graduate Institute of Medical Education and Research, Chandigarh96 enrolled

Overview

Comparison of two techniques of central venous cannulation of subclavian vein using ultrasound was performed. ultrasound guided central venous cannulation is the standard practice today but its use in subclavian vein is technically challenging and not much literature is available. In this study 96 Patients were randomized into one of the groups and compared for various outcomes. The primary outcome studied was the time taken for procedure. Secondary objectives included comparison of total access time using both the techniques,comparison of first attempt success rate, comparison of the quality of needle visualization and the comparison of immediate (mechanical) and delayed complication rates.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Compare Central Line Insertion of Subclavian Vein With Two Different Approaches Using Ultrasound

Interventions

ultrasound is a medical device which is frequently used for safe venous punctures as you can visualise the structures.so, device ''ultrasound'' will be used for intervention ''central line insertion'' in subclavian vein. ultrasound guided cannulation of the subclavian vein was done by supraclavicular or infraclavicular approach after randomization into either of the two groups.In the supraclavicular approach the puncture site is above the clavicle while in the infraclavicular group the puncture site is below the clavicle. Central venous cannulation is done after identifying the vein on ultrasound and using standard seldinger technique with full asepsis.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Healthy adults requiring central venous cannulation. Exclusion Criteria: * History of prior catheterization. * Limited sites for access attempts (other catheters, pacemaker, prior surgery). * Previous difficulties during catheterization such as more than three punctures at one site, two sites attempted or failure to gain access. * Previous mechanical complications during catheterization. * Patients with infection at puncture site and contralateral pneumothorax. * Patients with trauma to clavicle and upper ribs, distorted anatomy of neck or clavicles. * Cervical spine injury. * Known vascular abnormality. * Untreated coagulopathy such as International Normalization Ratio(INR) ≥ 2, activated partial thromboplastin time \>1.5 of normal or platelets \<50,000/mm3 * After 3 attempts at needle puncture.

Outcomes

Primary Outcomes

puncture time of subclavian vein using ultrasound-guided supraclavicular or infraclavicular approach infraclavicular approaches in adults

will be measured in seconds

Time frame: 1 year

Secondary Outcomes

total time taken for cannulation of veins using both the techniques.

measured in seconds

Time frame: 1 year

first attempt success rate

number of attempts taken will be measured

Time frame: 1 year

quality of needle visualisation

subjective visualisation of the needle on ultrasound will be noted as good or poor

Time frame: 1 year

immediate and delayed complications with the two approaches

Time frame: 1 year