About this trial
Most recent guidelines suggest central venous access must be performed with real-time ultrasound guidance, and the most recommended site for cannulation is internal jugular vein (IJV); however, it is recognized that evidence for other sites is, at present, limited. Besides, guidelines does not account for patients with small vein cross-sectional area and/or respirophasic collapse, which can make the procedure more difficult or even impossible. The investigators aim to compare three different insertion sites for central venous access, with real-time ultrasound guidance
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patients who need central venous catheterization, and have respirophasic variation in cross-sectional area of jugular veins
Disqualifiers
Less than 18 years-old
Patients with previous failed attempts with non-ultrasound guided technique
Non-resolved pneumothorax/hemothorax at enrollment
Refusal to sign informed consent
Trial design
Parallel
Treatments tested in this trial
Internal jugular vein catheterization
Procedure/SurgeryCatheterization of internal jugular vein with real-time (in-plane) method, with neutral neck position. Standard aseptic technique.
Subclavian vein catheterization
Procedure/SurgeryCatheterization of subclavian/axillary vein with infra-clavicular approach with real-time (in-plane) method, without shoulder retraction. Standard aseptic technique.
Innominate vein catheterization
Procedure/SurgeryCatheterization of innominate vein with supra-clavicular approach with real-time (in-plane) method, with neutral shoulder position and no shoulder retraction. Standard aseptic technique.
Treatment groups
Trial outcomes
Primary outcomes
Cannulation failure rate
Failure to cannulate selected vein at first attempt
Secondary outcomes
Central line-associated blood infection rate
Confirmed with blood cultures
Collapsibility associated with failure
Percentage of vein collapsibility independently associated with cannulation failure
Cannulation number of attempts
Number of attempts needed to attain cannulation
Procedure time
Time from skin puncture to guidewire confirmed into vessel (minutes)
Sponsors and contacts
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Hospital Civil de Guadalajara
Lead sponsor
Instituto Jalisciense de Cancerologia
Collaborator