Comparative efficacy of supraclavicular versus infraclavicular approach of subclavian vein cannulation under ultrasound guidance

Abstract

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.

Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial

“…Various studies and systematic reviews have compared the safety and efficacy of catheterization of both SC with the IC approach. 12 – 14 , 16 – 21 Byon HJ et al noted median puncture time in 98 children <3 years of age. The median puncture time for IC group was longer as compared to the SC group (48 vs 36 seconds) ( p = 0.02).…”

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

“…Pediatric percutaneous central venous catheters have improved the care of children requiring prolonged intravenous lines for prolonged therapy 1. Subclavian vein catheters (SVCs) can provide safe long-term venous access 2. However, several complications with an incidence ranging from 1% to 10% have been reported 3.…”

“… 1 Subclavian vein catheters (SVCs) can provide safe long-term venous access. 2 However, several complications with an incidence ranging from 1% to 10% have been reported. 3 The type, incidence and risk factors for complications depend on the experience of the healthcare team, the indications for central line insertion and the nursing skills.…”

Ultrasound-guided subclavian vein cannulation using open door technique – A technical report

“…We tried this technique in both right and left SCV (80% and 20%, respectively) successfully, and the results are comparable to other studies for the first successful attempt (90% vs 62.2% and 77.8%). [ 5 6 ] There were also no major complications like pneumothorax, arterial puncture, infection or misplaced catheters. Though the risk of pneumothorax and arterial punctures are present, it can be avoided by keeping the pleural movement in sonographic view and visualising the artery dynamically by tilting the probe during needle insertion, respectively.…”