Long-versus Short-Axis Ultrasound Guidance for Subclavian Vein Cannulation

Summary

Central venous catheterization is commonly applied in patients undergoing cardiac surgery. The subclavian vein has lower risk of infection and provides more patients comfort. However central venous catheterization may results in complications such as pneumothorax, hemothorax or arterial puncture. It has been suggested that ultrasound (US) guidance could improve the success rate, reduce the number of needle passes and decrease complications. Two different real-time 2-dimensional US techniques can be employed in the insertion of central venous catheters. The first technique involves real-time US-guided cannulation of subclavian vein using a long axis/in-plane approach. The second one involves real-time US-guided using a short axis/out-off-plane approach. However to date no studies have compared their efficacy and safety. The purpose of this study was to compare the US-guided long-axis versus short-axis approach for the SCV catheterization in adult critical care patients.

Conditions

• Vascular Access Complication
• Perioperative/Postoperative Complications

Interventions

DEVICE

Long Axis strategy

With the long-axis approach the vein appeared in the longitudinal view. With this approach only the vein was visible on the screen. The needle was held at a 30° angle, oriented in-plane with the transducer and the skin punctured at the base of the transducer. The vessel alignment was maintained during the procedure and the entire length of the needle was visible during the progression through the tissues.

DEVICE

Short Axis Strategy

With the short-axis approach the probe was positioned almost perpendicularly to the clavicle. The needle was held at an angle of 45° relative to the skin surface and sagittal to the plane of the probe (out-of-plane). During the progression to the vessel, the visualization of the needle was limited to the deformation of tissue and artefacts produced by needle advancement. When the tip abutted the vein wall, additional pressure produced transient vessel deformation, which disappeared once the wall was penetrated.

Sponsors & Collaborators

• Azienda Ospedaliero-Universitaria di Parma

  lead OTHER

Principal Investigators

• Antonella Vezzani, MD · Cardiac Surgery. Azienda Ospedaliero Universitaria di Parma

• Tiziano Gherli, MD · Cardiac Surgery. Azienda Ospedaliero Universitaria di Parma

• Tullio Manca, MD · Cardiac Surgery. Azienda Ospedaliero Universitaria di Parma

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

85 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2013-06-30

Primary Completion

2016-03-31

Completion

2016-03-31

Countries

• Italy

Study Locations