Frailty and Ultrasound-Guided Central Venous Catheterization Difficulty in Adult Cardiac Surgery Patients

This prospective observational study aims to evaluate the association between preoperative frailty and the procedural difficulty of ultrasound-guided internal jugular vein catheterization in adult patients undergoing elective cardiac surgery. Frailty will be assessed using the Clinical Frailty Scale and handgrip strength measurements. Preprocedural ultrasound evaluation will include internal jugular vein anatomical characteristics such as anteroposterior and transverse vein diameters, cross-sectional area (CSA), common carotid artery diameter, skin-to-vein distance, overlap status, and sternocleidomastoid muscle thickness Catheterization difficulty will be assessed using the Gaber Procedural Difficulty Index. The study seeks to determine whether frailty and ultrasound-derived anatomical parameters can predict difficult internal jugular venous catheterization and improve preprocedural risk assessment without altering routine clinical care.

Inclusion Criteria * Adults aged 18 years or older. * Scheduled for elective cardiac surgery. * Planned ultrasound-guided internal jugular vein catheterization as part of routine perioperative care. * Able to undergo preoperative frailty assessment using the Clinical Frailty Scale (CFS). * Able to perform handgrip strength measurement. * Able to undergo ultrasound assessment of the internal jugular vein. * Provided written informed consent. Exclusion Criteria Conditions Affecting Neck Anatomy 1. Previous neck surgery. 2. History of radiotherapy to the neck region. 3. Presence of a neck mass, infection, or any lesion that may distort neck anatomy. 4. Known internal jugular vein thrombosis. 5. Congenital vascular anomalies causing significant alteration of the internal jugular vein or carotid artery anatomy. Clinical Conditions Affecting Catheterization 1. Patients requiring emergency cardiac surgery. 2. Presence of an existing central venous catheter. 3. Severe coagulopathy (INR \> 2.0 or platelet count \< 50,000/mm³). 4. Hemodynamic instability or requirement for active cardiopulmonary resuscitation. Conditions Affecting Frailty and Handgrip Strength Assessment 1. Severe neurological disorders (e.g., advanced dementia or disabling sequelae of stroke). 2. Orthopedic or neuromuscular disorders affecting upper extremity function. 3. Inability to perform handgrip strength measurement due to severe arthritis or hand deformity. Conditions Affecting Study Participation 1. Cognitive impairment preventing reliable clinical assessment or informed participation. 2. Refusal to participate in the study. 3. Any other condition that, in the investigator's judgment, may compromise patient safety or interfere with study participation.