The INVADE Study: INnominate Vein Approach for Central Catheterization in Difficult to cannulatE Patients
The INVADE Study: INnominate Vein Approach for Central Catheterization in Difficult to cannulatE Patients
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
Ultrasound-guided cannulation of central veins is successful in >95% of the cases, according
 to the largest study so far. However, this and other studies with similar success rate, are
 performed in patients with general anesthesia and/or neuromuscular blockade, without
 spontaneous respiratory efforts. Critical care physicians and many other specialists
 frequently need to cannulate patients in special circumstances as hypovolemia, pain, anxiety,
 and respiratory efforts that promotes respirophasic variation in cross-sectional area, and
 even complete collapse of the vessel. These changes can increase the probability of posterior
 wall or arterial puncture, hematomas, pneumothorax, etc. Supraclavicular approach for
 cannulation of the subclavian vein is a method described since 1965, also giving direct
 access to the innominate vein, a larger vessel which is rarely collapsible regardless of
 volume status or respiratory efforts. Based on a previous pilot trial, in this multi-center,
 prospective, randomized, controlled trial, the investigators aim to compare the
 successfulness and safety of ultrasound-guided central venous cannulation at 3 different
 sites: internal jugular, subclavian, and innominate veins.
Inclusion Criteria:

 -  Patients who need central venous catheterization, and have respirophasic variation in
 cross-sectional area of jugular veins

 Exclusion Criteria:

 -  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