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To compare the frequency of first pass success by short axis versus long axis for cannulation of internal jugular vein.
This randomized controlled trial aims to compare the effectiveness of short-axis and long-axis ultrasound-guided approaches for cannulation of the internal jugular vein (IJV) in terms of first-pass success. Central venous catheterization is a commonly performed procedure for invasive monitoring and administration of medications and fluids. Ultrasound guidance has improved the safety and success of IJV cannulation compared with traditional landmark-based techniques; however, uncertainty remains regarding the optimal ultrasound imaging approach.
A total of 60 eligible patients undergoing IJV cannulation will be enrolled and randomly allocated into two equal groups. Participants in Group A will undergo ultrasound-guided IJV cannulation using the short-axis approach, while participants in Group B will undergo cannulation using the long-axis approach. All procedures will be performed by the researcher under direct supervision using standardized ultrasound-guided techniques.
The primary objective is to compare the frequency of first-pass success between the two approaches. First-pass success is defined as successful IJV cannulation with a single skin puncture and without needle redirection. Baseline demographic and clinical characteristics will be recorded before the procedure. The findings of this study may help identify the preferred ultrasound-guided technique for maximizing first-pass success during IJV cannulation and potentially reducing procedure-related complications associated with multiple cannulation attempts.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A (Short-Axis Approach) | Active Comparator | In this approach, IJV will be visualized by placing the transducer in a transverse orientation on the patient neck at the level of the cricoid cartilage. The needle will be inserted at 60° to the vertical and will be advanced toward the vein employing gentle aspiration on the attached syringe. Entry to the vein will be confirmed by visualizing indentation of the anterior wall of the vein followed by blood in the syringe and by visualizing the tip of the needle inside the vein. Guide wire will be passed followed by dilator insertion and finally central vein line. |
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| Group B (Long-Axis Approach) | Active Comparator | In this approach, the probe will be centered on the IJV and rotated through 90° in a clockwise direction resulting in long axis image of the vein. The needle insertion point will be directly beneath the most proximal end of the ultrasound probe. The needle will be inserted at 30° to the vertical and will be advanced toward the vein employing gentle aspiration. Entry to the vein will be confirmed by visualizing needle entry into the vein followed by aspiration of blood in the syringe. Guide wire will be inserted followed by dilator insertion and finally central vein line. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Short-Axis Ultrasound-Guided Internal Jugular Vein Cannulation | Device | Internal jugular vein cannulation performed under ultrasound guidance using the short-axis approach. The transducer is placed in a transverse orientation at the level of the cricoid cartilage, allowing visualization of the internal jugular vein and carotid artery during needle insertion. |
| Measure | Description | Time Frame |
|---|---|---|
| First-Pass Success Rate of Ultrasound-Guided Internal Jugular Vein Cannulation | First-pass success rate of ultrasound-guided internal jugular vein cannulation, defined as successful venous cannulation with a single skin puncture and needle pass. | Assessed during the cannulation procedure (within 5 minutes of initiation of cannulation). |
| Measure | Description | Time Frame |
|---|---|---|
| Total Cannulation Success Rate | Total cannulation success rate, defined as successful placement of the internal jugular venous catheter. | Assessed during the procedure (within 15 minutes). |
| Number of Needle Passes Required for Successful Cannulation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Waleed Noor, MBBS FCPS | Contact | +923154960902 | mrwaleed2394@gmail.com | |
| Shahida Khawaja, MBBS FCPS | Contact | +92 300 8462091 | khawaja.shahida@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Shahida Khawaja, MBBS, FCPS | National Hospital and Medical Center | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Hospital and Medical Center | Lahore | Punjab Province | 54000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27052071 | Background | Shrestha GS, Gurung A, Koirala S. Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein. Ann Card Anaesth. 2016 Apr-Jun;19(2):288-92. doi: 10.4103/0971-9784.179629. | |
| 31230925 | Background | Rath A, Mishra SB, Pati B, Dhar SK, Ipsita S, Samal S, Azim A. Short versus long axis ultrasound guided approach for internal jugular vein cannulations: A prospective randomized controlled trial. Am J Emerg Med. 2020 Apr;38(4):731-734. doi: 10.1016/j.ajem.2019.06.010. Epub 2019 Jun 14. |
| Label | URL |
|---|---|
| Should central venous pressure be used to guide critical care management? | View source |
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| Long-Axis Ultrasound-Guided Internal Jugular Vein Cannulation | Device | Internal jugular vein cannulation performed under ultrasound guidance using the long-axis approach. The transducer is rotated to obtain a longitudinal view of the internal jugular vein, allowing continuous visualization of the needle during vessel cannulation. |
|
Total number of needle insertion attempts required to achieve successful ultrasound-guided internal jugular vein cannulation.
| Recorded during the procedure. |
| Incidence of Hematoma Formation at the Cannulation Site | Occurrence of hematoma at the internal jugular vein cannulation site following ultrasound-guided catheter insertion. | Assessed immediately after the procedure and within 24 hours. |
| Incidence of Posterior Vessel Wall Puncture | Occurrence of unintended puncture of the posterior wall of the internal jugular vein during ultrasound-guided cannulation. | Assessed during the procedure. |
| Incidence of Pneumothorax Following Cannulation | Occurrence of pneumothorax associated with ultrasound-guided internal jugular vein cannulation. | Assessed within 24 hours following cannulation. |
| Overall Procedure-Related Complications | Frequency of procedure-related adverse events, including hematoma, posterior vessel wall puncture, pneumothorax, or other complications occurring during or after ultrasound-guided internal jugular vein cannulation. | Assessed during the procedure and up to 24 hours after cannulation. |
| 36322446 | Background | Tolson OW. Should central venous pressure be used to guide critical care management? Br J Hosp Med (Lond). 2022 Oct 2;83(10):1-3. doi: 10.12968/hmed.2022.0167. Epub 2022 Oct 11. |
| Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound-guide improves safety avoiding prophylactic platelet transfusion | View source |
| Short versus long axis ultrasound guided approach for internal jugular vein cannulations: A prospective randomized controlled trial | View source |
| Comparing 1st Pass Success Rate and Number of Attempts for Internal Jugular Vein Cannulation by USG Guided Approach: Short Axis versus Long Axis Technique | View source |
| A Comparative Study of Internal Jugular Vein Cannulation under Ultrasound Guidance Using Short Axis or Long Axis View Approach | View source |
| Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein | View source |