Safe placement of central venous catheters: where should the tip of the catheter lie?
S J Fletcher, A R Bodenham
https://pubmed.ncbi.nlm.nih.gov/10992821Actively Recruiting
Phase Not Applicable
Age: 18Years +
All Genders
ID07291869
A Randomised Feasibility Study of Real-time Intracavity ECG and Thoracic Ultrasound for Central Venous Catheter Tip Confirmation in Critical Care
Led by York Teaching Hospitals NHS Foundation Trust · Updated on 2026-06-02
75
Participants Needed
1
Research Sites
N/A
Total Duration
On this page
AI-Summary
What this Trial Is About
This research aims to evaluate the feasibility of two bedside methods to confirm the placement of central venous catheters (CVCs) and detect complications in critically ill patients. It compares intracavity electrocardiography (IC-ECG), which monitors heart electrical activity to guide catheter tip position, and thoracic point-of-care ultrasound (POCUS), which checks for pneumothorax after CVC insertion. The study is a single-center, prospective, randomized feasibility trial to improve speed and safety in CVC verification compared to standard chest X-ray. Participants needing an internal jugular vein CVC will be randomly assigned to one of three groups: CVC insertion on the left side with IC-ECG and thoracic POCUS, CVC insertion on the right side with these techniques, or standard care involving ultrasound-guided insertion with post-procedure chest X-ray only. All participants will receive a chest X-ray after the procedure to compare the new methods with standard care. Throughout the 12-month recruitment period, researchers will measure recruitment rates, protocol adherence, data completeness, technical success, and time taken to confirm catheter tip position. They will also monitor complications up to 48 hours after insertion, review ultrasound and ECG images for consistency, assess operator confidence, and evaluate how often chest X-rays might be avoided. The study will help design larger future trials to assess accuracy and cost-effectiveness of these techniques in critical care.
CONDITIONS
Brief Title
Central Venous Catheter Placement With Thoracic Ultrasound and Intracavity ECG Positioning
Who Can Participate
Age: 18Years +
All Genders
Eligibility Criteria
You may qualify if you...
- Adult (aged 65 18 years)
- Admitted, or planned for admission, to critical care
- Requiring central venous catheter insertion as a part of usual care
- Suitable for insertion in either right or left internal jugular vein
You will not qualify if you...
- Previously randomised into this study
- Atrial fibrillation on 12-lead ECG
- Cardiovascular instability, including noradrenaline dose above 0.5 mcg/kg/min or rapidly increasing vasopressor doses
- Difficulty obtaining thoracic ultrasound images due to weight over 120kg, existing pneumothorax, subcutaneous emphysema, or chest wall wounds/dressings
- Existing pacemaker
- Non-English speaking
- Imminent death perceived
- Any other reason judged by treating clinician to exclude participation
AI-Screening
AI-Powered Screening
Complete this quick 3-step screening to check your eligibility
1
2
3
Your Study Journey
Screening
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Central Venous Catheter Placement
Duration - Procedure day
Participants undergo insertion of a central venous catheter (CVC) in either the left or right internal jugular vein, guided by ultrasound. Depending on randomization, catheter tip confirmation is performed using intracavity ECG and thoracic point-of-care ultrasound to assess catheter position and exclude pneumothorax.
1 procedure visit (in-person)
Post-procedure Chest X-ray and Monitoring
Duration - Up to 48 hours post-procedure
After catheter placement, participants receive a chest X-ray to confirm catheter tip position and check for complications. Participants are monitored for complications for up to 48 hours post-procedure.
Approximately 1 to 2 visits within 48 hours
Follow-up Image Review and Assessment
Duration - Up to 28 days post-procedure
Images obtained during the procedure are reviewed up to 28 days post-procedure to assess inter-operator reliability of intracavity ECG and thoracic ultrasound findings.
No direct participant visits; assessments conducted through image review
Trial Site Locations
Total: 1 location
1
York and Scarborough Teaching Hospitals NHS Foundation Trust
York, North Yorkshire, United Kingdom, YO31 8HE
Actively Recruiting
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Research Team
A
Andrew Chamberlain, MBChB
J
Joseph Carter, MBChB
How is the study designed?
Study Type
INTERVENTIONAL
Masking
SINGLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
BASIC_SCIENCE
Number of Arms
3
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Published Research Related To This Trial
Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study.
Minwoo Kang, Jinkun Bae, Sujin Moon...
https://pubmed.ncbi.nlm.nih.gov/33397666