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Catheterization, Central VenousNCT03077802

Ultrasound Guided Central Venous Catheterization: Seldinger vs. Modified Seldinger Technique

A study testing Modified Seldinger technique, Experienced group, Seldinger technique, Experienced group and Modified Seldinger technique, Inexperienced group in people with Catheterization, Central Venous, run by Seoul National University Hospital at 1 site in South Korea.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The investigators intend to compare the Seldinger technique and modified Seldinger technique on success rate and complications during central venous catheterization by a prospective, randomized, controlled study. Read more about this study

Who is it for?
Ages 20 years and older
Conditions the study is for
Catheterization, Central Venous
What is being tested?
Modified Seldinger technique, Experienced group, Seldinger technique, Experienced group and Modified Seldinger technique, Inexperienced group
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
308 participants
Where
1 siteSouth Korea
Study dates
Oct 2015to 28 Feb 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • patient scheduled for surgery and internal jugular vein central catheterization

Who cannot join

  • Patient who doesn't agree to the study
  • Catheterization site inflammation
  • Contralateral diaphragmatic dysfunction
  • Anatomic anomalies of carotid artery or vein
  • Previous neck surgical history
  • Recent (less than 1 month) right internal jugular vein central catheterization

Trial locations and contacts

1 site in 1 country.

South Korea1 site
  • Seoul National University Hospital

    Seoul, 03080

Other trials in South Korea

About this study

Official title: Comparison of Two Needle Insertion Techniques on Success Rate and Complications During Ultrasound Guided Central Venous Catheterization: Seldinger vs. Modified Seldinger Technique

The investigators intend to compare the Seldinger technique and modified Seldinger technique on success rate and complications during central venous catheterization by a prospective, randomized, controlled study. The investigators are planning to compare both techniques in both experienced (anesthesiologist board member) and non-experienced practitioners (first and second-grade resident).

Read the detailed description

Unintended arterial puncture and local hematoma formation are the most common complications during internal jugular vein central venous catheterization. Other serious complications like pseudoaneurysm, arteriovenous fistula, arterial dissection, thrombosis, embolism are also possible. These complications mostly occur by mechanical trauma or injury when advancing needle back and forth to puncture internal jugular vein. Placement of guidewire or dilator can also cause mechanical trauma or injury around the vessel.

Because internal jugular vein collapses easily during needle advance, anterior and posterior wall of the vessel can be punctured simultaneously. Posterior wall puncture can increase the risk of complications of the catheterization. Delicate puncture of the vessel and stable fixation of the needle after puncture are important to reduce overall number of catheterization attempts, increase success rate, reduce complications.

Seldinger technique(thin-wall needle technique) is commonly used procedure to obtain safe access to central vein. The desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel. Contrarily, modified Seldinger technique(guiding sheath-over-the-needle technique) use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel.

When using Seldinger technique, it is important to fix the needle firmly with hand until the guidewire is placed into the vessel lumen. If hand fixation is not stable, needle tip can migrate from the lumen, can pierce the vessel wall, and carotid artery puncture, and local hematoma formation might occur. Even if there is no evidence of complications, when blood regurgitation fails, overall number of vessel puncture attempts would increase and it is expected that rate of complications of the catheterization would increase.

When using modified Seldinger technique, guiding sheath is easily slid over the needle, providing stable route into the vessel lumen relatively in early step of the catheterization. Therefore, it is expected that stability of the fixation improves, success rate of the catheterization increase, and complications of the catheterization decrease. But there is no high level of evidence yet, and still decision to use which technique is based on experience of the operator.

The investigators are going to compare the Seldinger technique and modified Seldinger technique on success rate and complications during central venous catheterization by prospective, randomized, controlled study.

In addition, any difference in success rate and complications between the two techniques may be different depending on the experience of the practitioners. Therefore, the investigators also plan to compare the two techniques between experienced and non-experienced practitioners.

The success rate and complications between the two techniques may also be different depending on the long and short-axis techniques. As subgroup analyses, we intend to investigate whether there is a difference between Seldinger and modified Seldinger technique according to the experience of the operator or long or short axis approach.

Being tested
Modified Seldinger technique, Experienced group, Seldinger technique, Experienced group, Modified Seldinger technique, Inexperienced group, Seldinger technique, Inexperienced group, Long-axis technique
Keywords
Seldinger technique, Modified Seldinger technique, Complication, Success rate

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Modified Seldinger technique, Experienced groupOther

    This is a technique for central venous catheterization. We will use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel. The procedure will be performed by experienced practitioners who are board-certified anesthesiologist staffs and have experience of more than 50 central venous catheterizations in both techniques.

  • Seldinger technique, Experienced groupOther

    This is a technique for central venous catheterization. The desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel. The procedure will be performed by experienced practitioners who are board-certified anesthesiologist staffs and have experience of more than 50 central venous catheterizations in both techniques.

  • Modified Seldinger technique, Inexperienced groupOther

    This is a technique for central venous catheterization. We will use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel. This technique will be performed by inexperienced practitioners who are junior residents and have experience of less than 50 central venous catheterizations in both techniques.

  • Seldinger technique, Inexperienced groupOther

    This is a technique for central venous catheterization. The desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel. This technique will be performed by inexperienced practitioners who are junior residents and have experience of less than 50 central venous catheterizations in both techniques.

  • Long-axis techniqueOther

    Ultrasound probe is placed parallel to the vessel trajectories and needle is advanced using in-plane approach.

  • Short-axis techniqueOther

    Ultrasound probe is placed vertical to the vessel trajectories and needle is advanced using out-of-plane approach.

Study groups in NCT03077802
Study groupRoleWhat they receive
Modified Seldinger technique, Experienced groupExperimentalUnder ultrasound-guide, we will use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel. The procedure will be performed by experienced practitioner who were defined as board-certified anesthesiologist staffs and had experience of more than 50 central venous catheterizations in both techniques.
Receives: Other: Modified Seldinger technique, Experienced group; Other: Long-axis technique; Other: Short-axis technique
Seldinger technique, Experienced groupActive comparatorUnder ultrasound-guide, the desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel. The procedure will be performed by experienced practitioner who were defined as board-certified anesthesiologist staffs and had experience of more than 50 central venous catheterizations in both techniques.
Receives: Other: Seldinger technique, Experienced group; Other: Long-axis technique; Other: Short-axis technique
Modified Seldinger technique, Inexperienced groupExperimentalUnder ultrasound-guide, we will use needle that is covered with guiding sheath. After desired vessel puncture, guiding sheath is instantly slid over the needle into the vessel. The needle is withdrawn, guidewire is advanced through the guiding sheath, central catheter is placed into the vessel. The procedure will be performed by inexperienced practitioner who were junior residents and had experience of less than 50 central venous catheterizations in both techniques.
Receives: Other: Modified Seldinger technique, Inexperienced group; Other: Long-axis technique; Other: Short-axis technique
Seldinger technique, Inexperienced groupActive comparatorUnder ultrasound-guide, the desired vessel is punctured with a sharp hollow needle, syringe is detached and guidewire is advanced through the lumen of the needle, and then the needle is withdrawn. Central catheter is then passed over the guidewire into the vessel. The procedure will be performed by inexperienced practitioner who were junior residents and had experience of less than 50 central venous catheterizations in both techniques.
Receives: Other: Seldinger technique, Inexperienced group; Other: Long-axis technique; Other: Short-axis technique

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. number of attempts of needle advance for successful venous puncture

    number of attempts of needle advance (number of needling attempt)

    Measured: 5 min after internal jugular vein catheterization

Secondary outcomes (10)
  1. incidence of arterial puncture

    incidence of arterial puncture during internal jugular vein catheterization

    Measured: 5 min after internal jugular vein catheterization

  2. incidence of local hematoma

    incidence of jugular venous hematoma during internal jugular vein catheterization

    Measured: 5 min after internal jugular vein catheterization

  3. incidence of pneumothorax

    incidence of pneumothorax during internal jugular vein

    Measured: 5 min after internal jugular vein catheterization

  4. incidence of hemothorax

    incidence of hemothorax during internal jugular vein

    Measured: 5 min after internal jugular vein catheterization

  5. Time to successful jugular venous catheterization

    incidence of hemothorax during internal jugular vein (overall procedure time)

    Measured: 5 min after internal jugular vein catheterization

  6. number of attempts of needle advance

    number of attempts of needle advance

    Measured: 5 min after internal jugular vein catheterization

  7. number of attempts of catheter advance

    number of attempts of needle advance (only in modified Seldinger group)

    Measured: 5 min after internal jugular vein catheterization

  8. incidence of successful central venous catheterization

    incidence of successful central venous catheterization (success defined as completion of catheterization within three attempts of needle advance)

    Measured: 5 min after internal jugular vein catheterization

  9. grade of resistance during dilator insertion

    grade of resistance during dilator insertion (grade 1: easy, grade 2: moderate, grade 3: difficult, use of blade for skin incision

    Measured: 5 min after internal jugular vein catheterization

  10. number of attempts of guidewire advance

    number of attempts of guidewire advance through the lumen of needle or guidewire sheath after desired vessel is punctured

    Measured: 5 min after internal jugular vein catheterization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Mar 2017
  2. Study startOct 2015
  3. Primary completion28 Feb 2019
  4. Study completion28 Feb 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
randomized controlled trial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
308 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03077802
Sponsor's protocol ID
1506-126-684
Status last verified
Dec 2019
First submitted
8 Mar 2017
Last updated
12 Dec 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Yoon HK, Hur M, Cho H, Jeong YH, Lee HJ, Yang SM, Kim WH. Effects of practitioner's experience on the clinical performance of ultrasound-guided central venous catheterization: a randomized trial. Sci Rep. 2021 Mar 24;11(1):6726. doi: 10.1038/s41598-021-86322-y.

    PubMed 33762662

Questions about this trial

What is this clinical trial studying?

A study testing Modified Seldinger technique, Experienced group, Seldinger technique, Experienced group and Modified Seldinger technique, Inexperienced group in people with Catheterization, Central Venous, run by Seoul National University Hospital at 1 site in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Dec 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

number of attempts of needle advance for successful venous puncture (time frame: 5 min after internal jugular vein catheterization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03077802, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Dec 2019.

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