Comparison between supraclavicular and infraclavicular approaches for subclavian venous catheterization in adults

Abstract

Introduction:The subclavian vein access has been the standard recommended approach for central venous catheterization both for short and long-term use. Aim is to compare the supraclavicular and infraclavicular approaches for subclavian venous cannulation in regard to success, attempts required, time taken and complications. Material and Methods: All patients satisfying the inclusion criteria were placed either in group supraclavicular (S) or group infraclavicular (I) approach for right subclavian vein and 7FrG cannula was cannulated using modified Seldinger technique under general anaesthesia. Results: Time taken for successful cannulation in Group (S) were 188.96 + 37.19 seconds and in Group (I) were 299.76 + 69.712 seconds which was statistically significant with p value of <0.001. Success of cannulation in Group (S) was 95 %, where as in Group (I) was 92.5%. In Group (S) 85% cannulas were secured in 1 st attempt, 10% in 2 nd attempt and 5% had failed cannulation. In Group (I) 67.5% were secured in 1 st attempt, 25% in 2 nd attempt and 7.5% had failed cannulation. Complications in terms of arterial puncture, malposition and pneumothorax were comparable. All these parameters were not statistically significant between the groups with p value >0.05. Supraclavicular approach is better than infraclavicular approach in terms of less mean time required for successful cannulation. Conclusion: Subclavian venous catheterization via the supraclavicular approach is aquicker method of central venous access in anesthesia.

Subclavian vein catheterization: Comparative evaluation of supraclavicular versus infraclavicular approach in oncology patients

“…But overall success rate in group SC was 93.33% whereas, 90% in group IC which is not statistically significant. This was comparable with S Govindswamy et al 17 study. The failure rate in that study were only due to inability to locate vein.…”

Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials

“…[ 5 ] Finally, 17 studies (2568 cases to 2482 cases) from 23 reports were included in this review [ Table 1 ] (NCT04637347). [ 3 , 5 - 7 , 20 - 31 ]…”

“…In our meta-analysis, data from 17 trials comprising 2482 participants in whom the failure proportion was measured were pooled [ Table 2 , Figures 2 and 3a ] (NCT04637347). [ 3 , 5 - 7 , 20 - 31 ] The comprehensive results revealed that the SC approach likely reduced the failure proportion compared with the IC approach (RR, 0.63; 95% CI, 0.47–0.86; I 2 = 5%; moderate quality) [ Table 2 , Figure 3a ]. In addition, eight trials that met our definition of failure proportion were subjected to sensitivity analysis ( ).…”

“…(NCT04637347). [ 3 , 5 - 7 , 20 - 30 ] The comprehensive results revealed that the SC approach may decrease the incidence of puncture-related complications slightly compared with the IC approach (RR, 0.61; 95% CI, 0.36–1.03; I 2 = 0%; low quality) [ Table 2 , Figure 3c ]. In addition, seven trials that met our definition of arterial puncture and pneumothorax were subjected to sensitivity analysis [ ].…”

“…[ 5 ] The IC approach has been the traditional and routinely practised technique since 1952, whereas the SC approach has been used since 1965. [ 6 , 7 ]…”