Background and Aims: Subclavian vein (SCV) cannulation can be performed using either supraclavicular (SC) or infraclavicular (IC) long-axis approach under ultrasound guidance (USG). However, their relative efficacy remains debatable. The aim of this study was to compare these two approaches in terms of safety, ease, success rate, and record the incidence of complications. Methods: We studied 90 adult patients distributed into two groups of 45 each. Data regarding the time taken for first venous puncture, the time required for inserting the catheter, the total number of attempts, the incidence of guidewire misplacement, and other mechanical complications were compared using Student's t-test for quantitative data and Chi-square test for qualitative value. Results: Mean puncture time was significantly lesser in group SC than IC ( P -value < 0.001). Mean catheter insertion time taken was also significantly less in group SC than IC ( P -value = 0.003). The first attempt rate was higher in group SC than IC ( P = 0.013). Guidewire misplacement was seen in the IC group, P = 0.001. No pneumothorax, haemothorax, or arterial puncture were noted in our study in any of the groups. Conclusion: We conclude that for right-sided SCV cannulation using USG in the long axis, the SC approach is superior to the IC approach in terms of overall ease of cannulation. It was associated with a relatively shorter procedure time, higher success rate in the first attempt, lesser incidence of guidewire misplacement, and other complications. It should be considered as an alternative approach to the IC approach in patients requiring central line insertion.

Cardiac Tamponade is usually consequence of increased pericardial pressure with accumulation of pericardial effusion. We are reporting a case of acute kidney injury after mitral valve replacement due to acute pericardial effusion with clot. A 38-year-old female presented to CTVS department of our institute with history of palpitations and shortness of breath. On further examination and investigations she was diagnosed with severe mitral stenosis. Mitral valve replacement was done for her. In post operative period she developed cardio renal syndrome due to cardiac tamponade which presented as acute kidney injury. Re-exploration was done and clot was removed. She was shifted to ward after post operative monitoring and extubation.

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