Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back

Abstract

Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.

Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital

“…SCV is an alternative to internal jugular vein (IJV) when this is difficult to locate, as in hypovolemic or obese patients 4,5 . SCV cannulation has the advantage of fixed landmarks but may be associated with potentially severe complications, e.g., pneumothorax or hemothorax, likely related to limited operator experience 6 .…”

Chest wall-parallel vs. conventional subclavian venous catheterization in cancer chemotherapy: A comparison of complication rates

“…One study demonstrates that to use of real-time US guidance for infraclavicular placement of SCV catheters can lead to decreased mechanical complications and improved cannulation success ( 11 ). The alternative cannulations require advanced training and experience ( 12 ).…”

Aortic Cannulation: An Unexpected Complication of Central Venous Catheter Placement

“…Multiple studies showed that compared to anatomic landmark techniques, ultrasound guidance was associated with 71% reduction in catheter-related complications for internal jugular vein placement. 5 Emerging data also support the use of ultrasound in infraclavicular subclavian vein access. 5,6 Ultrasound would have prevented this complication in our patient.…”

“…5 Emerging data also support the use of ultrasound in infraclavicular subclavian vein access. 5,6 Ultrasound would have prevented this complication in our patient. However, it was not then performed routinely in our institution.…”