Facilitating Needle Alignment With Aiming Method

Daping Hospital and the Research Institute of Surgery of the Third Military Medical University474 enrolled

Overview

Although ultrasound-guided catheterization of the subclavian vein is becoming standard procedure in anesthetic practice, failure to align the needle and the transducer still can lead to possibly complications. In this study, we proposed a new alignment method, namely Aiming Method. The purpose of this study is to investigate whether the use of this aiming method improved resident volunteers' performance of ultrasound-guided SC insertion in real patients. Specifically, residents were asked to perform three different methods: landmark techniques, ultrasound-guided with aiming method and ultrasound-guided plus needle guide techniques.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

474

Conditions

Central Venous Catheters

Interventions

Here we introduced a new freehand method, named as Aiming Method, which facilitated the alignment of injection needles with ultrasound beams. During this aiming method, patient is still positioned in Tredelenburg with the arm abducted to 90° and no needle guidance will be used.

landmark techniquesPROCEDURE

The patient is positioned in Tredelenburg with the arm abducted to 90°. Venipuncture should occur 1 cm lateral to the curvature of the middle third of the clavicle with the needle pointing horizontally directed at the sternal notch. If subclavian vein is missing at the first try, withdraw the needle and direct horizontally at the cricoid cartilage at the second try.

Ultrasound-guided plus needle guide techniquesPROCEDURE

Subclavian vein catheterization is performed under ultrasound guidance with in-plane technique. The patient is positioned in Tredelenburg with the arm abducted to 90°. During the needle insertion, the needle is secured in the needle guidance device which keeps the alignment of needle and ultrasonic beam.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years to 70 years * American Society of Anesthesiologists (ASA) Physical Status Ⅰ-Ⅲ * Elective surgery patients requiring subclavian vein catheterization Exclusion Criteria: * Local anatomic abnormalities in subclavicular area * Preexisting subclavian vein thrombosis or coagulation disorders * Refusal of subclavian vein catheterization

Outcomes

Primary Outcomes

Procedural time

the time from skin break to guide wire was positioned into the subclavian vein

Time frame: 24 hours

Number of skin breaks

number of skin punctures

Time frame: 24 hours

Secondary Outcomes

The incidence of arterial puncture

aspiration of arterial blood during needle insertion or local haematoma in ultrasound image

Time frame: 24 hours

The incidence of pneumothorax

aspiration of air during needle insertion, or thoracic ultrasonography, or chest radiography

Time frame: 24 hours

Facilitating Needle Alignment With Aiming Method

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes