Right Versus Left Distal Axillary Vein Cannulation
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age20-70
SponsorAlexandria University
About this trial
Central venous cannulation is an essential procedure in the anaesthetic and critical care practice. Ultrasound has revolutionized the practice favoring the internal jugular cannulation to the other sites .Subcalvian vein cannulation has fallen out of favor mainly due to the difficult visualization with the ultrasound, especially in obese patients and the inevitable position of the clavicle acting as a bony obstacle , in addition to the anatomical position in vicinity to the pleura which might raise the risk of pneumothorax . Indeed the subclavian vein cannulation is more comfortable and tolerated by the patient especially those requiring long term intravenous therapy, with less rates of infection and thrombosis. This mandated the development of a safer and efficient technique for the cannulation empowered by the ultrasound technology.
The infracalvicular approach or the proximal axillary vein cannulation has been described but is not popular. It provides a potentially safer and successful technique with less complication both in "experienced" and "less experienced"operators . All the patients will receive general anaesthesia with laryngeal mask insertion . Careful sterilization of the surgical site and strict aseptic techniques for the handling of the ultrasound probe will be pursued
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
None
Disqualifiers
Abnormalities in the platelet count or coagulation
Thrombosis of the target vein
Soft tissue infection of the overlying area
Fracture of the clavicle or proximal ribs
Trial design
Design model
Parallel
Treatments tested in this trial
Ultrasound guided right infraclavicular approach of subclavian vein cannulation
Procedure/SurgeryAll patients will be in supine position, with the arm abducted to 45 degrees , the angle of the arm will be increased to 90 degrees to best acquire the image.The probe will be placed in he parasgittal plane in the deltopectoral groove medial to the coracoid process . The image will be optimized regarding the depth , focus and the gain accorgingly for the best image of the axillary artery and vein similar to that acquired when performing an infraclavicular approach for brachial plexus block . The probe will be rotated to obtain a longitudinal image of the axillary vein . The needle will be introduced in real time imaging , in an inplane technique and blood will be aspirated , the guidewire will be introduced in real time imaging.The internal jugular vein will be scanned bilaterally via ultrasonography to exclude malposition of the guidewire and will be reported in case of such. The catheter will be introduced through the sheath and will be tunneled the skin.
Ultrasound guided left infraclavicular approach of subclavian vein cannulation
Procedure/SurgeryAll patients will be in supine position, with the arm abducted to 45 degrees , the angle of the arm will be increased to 90 degrees to best acquire the image.The probe will be placed in he parasgittal plane in the deltopectoral groove medial to the coracoid process . The image will be optimized regarding the depth , focus and the gain accorgingly for the best image of the axillary artery and vein similar to that acquired when performing an infraclavicular approach for brachial plexus block . The probe will be rotated to obtain a longitudinal image of the axillary vein . The needle will be introduced in real time imaging , in an inplane technique and blood will be aspirated , the guidewire will be introduced in real time imaging.The internal jugular vein will be scanned bilaterally via ultrasonography to exclude malposition of the guidewire and will be reported in case of such. The catheter will be introduced through the sheath and will be tunneled the skin.
Treatment groups
80 Participants
are divided into 2 treatment groupsGroup A: Right subclavian vein cannulationOther 1 intervention
Group B: Left subclavian vein cannulationExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Incidence of Successful cannulation
Recognition of the catheter in the SVC by fluoroscopy
Time frame
Directly after the end of the procedureSecondary outcomes
1
Rate of malposition identified by the ultrasound
The ultrasound probe will be positioned on the internal jugular vein for the recognition of malposition of the guidewire
Time frame
Directly after the insertion of the guidewire and the catheter2
Complication of the procedures
All the complications will be recognized and reported
Time frame
Directly at the end of the procedureSponsors and contacts
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Source ClinicalTrials.gov