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VOLUME 17 , ISSUE 1 ( February, 2013 ) > List of Articles


Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited

Gaurav Singh Tomar, Sonali Chawla, Suprio Ganguly, Grace Cherian, Akhilesh Tiwari

Keywords : Central venous catheter cannulation, complications, emergency, supraclavicular method

Citation Information : Tomar GS, Chawla S, Ganguly S, Cherian G, Tiwari A. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited. Indian J Crit Care Med 2013; 17 (1):10-15.

DOI: 10.4103/0972-5229.112145

License: CC BY-ND 3.0

Published Online: 01-04-2014

Copyright Statement:  Copyright © 2013; The Author(s).


The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required.

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  1. Turcotte S, Dubé S, Beauchamp G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006;8:1605-19.
  2. Aubaniac R. A new route for venous injection or puncture: The subclavicular route, subclavian vein, brachiocephalic trunk. Sem Hop 1952;28:3445-7.
  3. Yoffa D. Supraclavicular subclavian venepuncture and catheterization. Lancet 1965;2:614-7.
  4. Brahos GJ. Central venous catheterization via the supraclavicular approach. J Trauma 1977;17:872-7.
  5. Brahos GJ, Cohen MJ. Supraclavicular central venous catheterization: Technique and experience in 250 cases. Wisconsin Med J 1981;80:36-8.
  6. Muhm M, Sunder-Plassmann G, Apsner R, Kritzinger M, Hiesmayr M, Druml W. Supraclavicular approach to the subclavian/innominate vein for large-bore central venous catheters. Am J Kidney Dis 1977;30:802-6.
  7. Apsner R, Schulenburg A, Sunder-Plassmann G, Muhm M, Keil F, Malzer R, et al. Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route. Bone Marrow Transplant 1998;21:1149-52.
  8. Dronen S, Thompson B, Nowak R, Tomlanovich M. Subclavian vein catheterization during cardiopulmonary resuscitation: A prospective comparison of the supraclavicular and infraclavicular percutaneous approaches. JAMA 1982;247:3227-30.
  9. Gorchynski J, Everett WW, Pentheroudakis E. A modified approach to supraclavicular subclavian vein catheter placement: The pocket approach. Calif J Emerg Med 2004;5:50-4.
  10. Conroy JM, Rajagopalan PR, Baker JD 3rd, Bailey MK. A modification of the supraclavicular approach to the central circulation. South Med J 1990;83:1178-81.
  11. MacDonnell JE, Perez H, Pitts SR, Zaki SA. Supraclavicular subclavian vein catheterization: Modified landmarks for needle insertion. Ann Emerg Med 1992;21:421-4.
  12. Jung CW, Seo JH, Lee W, Bahk JH. A novel supracalvicular approach to the right subclavian vein based on Three-dimensional computed tomography. Anesth Analg 2007;105:200-4.
  13. Czarnik T, Gawda R, Perkowski T, Weron R. Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients. Anesthesiology 2009; 111:334-9.
  14. Elliott TS, Faroqui MH, Armstrong RF, Hanson GC. Guidelines for good practice in central venous catheterization. Hospital Infection Society and the Research Unit of the Royal College of Physicians. J Hosp Infect 1994;28:163-76.
  15. Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, et al. Central vein catheter-related thrombosis in intensive care patients: Incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998;114:207-13.
  16. Nevarre DR, Domingo OH. Supraclavicular approach to subclavian catheterization: Review of the literature and results of 178 attempts by the same operator. J Trauma 1997;42:305-9.
  17. Garcia JM, Mispireta LA, Pinho RV. Percutaneous supraclavicular superior vena caval cannulation. Surg Gynecol Obstet 1972;134:839-41.
  18. Haapaniemi L, Slatis P. Supraclavicular catheterization of the superior vena cava. Acta Anaesth Scand 1974;18:12-22.
  19. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123-33.
  20. Silberzweig JE, Mitty HA. Central venous access: Low internal jugular vein approach using imaging guidance. AJR Am J Roentgenol 1998;170:1617-20.
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