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VOLUME 28 , ISSUE 4 ( April, 2024 ) > List of Articles

Original Article

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

Pooja Jaiswal, Suman Saini, Priyanka H Chhabra

Keywords : Access, Complications, Infraclavicular, Route, Subclavian, Supraclavicular, Ultrasound

Citation Information : Jaiswal P, Saini S, Chhabra PH. Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial. Indian J Crit Care Med 2024; 28 (4):375-380.

DOI: 10.5005/jp-journals-10071-24686

License: CC BY-NC 4.0

Published Online: 30-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background and objectives: The subclavian vein is frequently cannulated using ultrasound. There are two techniques of subclavian vein catheterization (SVC): Supraclavicular (SC) and infraclavicular (IC). Though the IC route is often preferred, the SC approach offers several distinct advantages. This study was planned to compare the technique of SVC using SC and IC approaches in terms of catheterization technique and complications in elective surgeries in adults. Methods: Sixty American Society of Anesthesiologists (ASA) 1, 2, or 3 adult patients posted for elective surgeries under general anesthesia were recruited. Patients were divided into SC or IC groups randomly. Right-sided subclavian vein was cannulated in both the groups (n = 30). Visualization time, Likert scale, subclavian vein diameter, skin-to-subclavian vein depth, number of attempts, puncture time, ease of guidewire insertion, catheter insertion time, and total procedural time were observed. A comparison of complications for each approach was noted. Results: Total procedural time, time to visualization of the subclavian vein, and puncture time was lower for group SC and higher for group IC. Catheter insertion time was higher with the IC approach than with the SC approach. Better ultrasound view scores were seen in group SC than in group IC. The first attempt success rate was higher in group SC than in group IC. Comparatively, lower complications both during and after the procedure were noted in the SC approach than the IC approach. Conclusion: Ultrasonography (USG) guidance guided SC approach to access the subclavian vein is quicker, relatively secure, and a better technique than the IC approach. Additionally, the SC approach is associated with comparatively fewer immediate and delayed complications.


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  1. Osmić I, Resić H, Barhawi H, Avdić E, Helać-Cvijetić D, Miseljić S, et al. Central venous catheters for haemodialysis and optimal blood flow. Med Arh 2006;60(4):237–239. PMID: 16761517.
  2. Yoffa D. Supraclavicular subclavian venepuncture and catheterisation. Lancet 1965;2(7413):614–617. DOI: 10.1016/s0140-6736(65)90519-2.
  3. Parienti JJ, du Cheyron D, Timsit JF, Traoré O, Kalfon P, Mimoz O, et al. Meta-analysis of subclavian insertion and non tunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med 2012;40(5):1627–1634. DOI: 10.1097/CCM.0b013e31823e99cb.
  4. Tarbiat M, Manafi B, Davoudi M, Totonchi Z. Comparison of the complications between left side and right side subclavian vein catheter placement in patients undergoing coronary artery bypass graft surgery. J Cardiovasc Thorac Res 2014;6(3):147–151. DOI: 10.15171/jcvtr.2014.003.
  5. Sidoti A, Brogi E, Biancofiore G, Casagli S, Guarracino F, Malacarne P, et al. Ultrasound- versus landmark-guided subclavian vein catheterization: A prospective observational study from a tertiary referral hospital. Sci Rep 2019;9(1):12248. DOI: 10.1038/s41598-019-48766-1.
  6. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med 2011;39(7):1607–1612. DOI: 10.1097/CCM.0b013e318218a1ae.
  7. Aubaniac R. Subclavian intravenous injection; advantages and technic. Presse Med 1952;60(68):1456. PMID: 13027062.
  8. Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: The forgotten central line. West J Emerg Med 2009;10(2):110–114. PMID: 19561831.
  9. Brahos GJ, Cohen MJ. Supraclavicular central venous catheterization: Technique and experience in 250 cases. Wis Med J 1981;80(2):36–38. PMID: 7233965.
  10. Chen Q, Long Q, Liang JQ, Tang TX, Yang B. Comparative evaluation of the clinical safety and efficiency of supraclavicular and infraclavicular approaches for subclavian venous catheterization in adults: A meta-analysis. Am J Emerg Med 2020;38(7):1475–1480. DOI:10.1016/j.ajem.2020.04.015.
  11. 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.
  12. Raphael PO, Simon BP, Thankappan C, Chacko L. Comparison between ultrasound guided supraclavicular and infraclavicular approaches for subclavian venous catheterisation in adults. J Evid Based MedHealthc 2016;36:774–778. DOI: 10.18410/jebmh/2016/397.
  13. Kim YJ, Ma S, Yoon HK, Lee HC, Park HP, Oh H. Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: A randomized controlled non-inferiority trial. Anaesthesia 2022;77(1):59–65. DOI: 10.1111/anae.15525.
  14. Prasad R, Soni S, Janweja S, Rajpurohit JS, Nivas R, Kumar J. Supraclavicular or infraclavicular subclavian vein: Which way to go-A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance. Indian J Anaesth 2020;64(4):292–298. DOI: 10.4103/ija.IJA_930_19.
  15. Srinivasan NM, Kumar A. Finding on a chest radiograph: A dangerous complication of subclavian vein cannulation. Indian J Crit Care Med 2010;14(2):95–96. DOI: 10.4103/0972-5229.68225.
  16. Mageshwaran T, Singla D, Agarwal A, Kumar A, Tripathy DK, Agrawal S. Comparative efficacy of supraclavicular versus infraclavicular approach of subclavian vein cannulation under ultrasound guidance: A randomized clinical trial. Indian J Anaesth 2021;65(Suppl 2):S69–S73. DOI: 10.4103/ija.IJA_1316_20.
  17. Souadka A, Essangri H, Boualaoui I, Ghannam A, Benkabbou A, Amrani L, et al. Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study. PLoS One 2020;15(11):e0242727. DOI: 10.1371/journal.pone.0242727.
  18. Saini V, Vamsidhar A, Samra T, Sethi S, Naik BN. Comparative evaluation of ultrasound guided supraclavicular and infraclavicular subclavian venous catheterizations in adult patients. J Anaesthesiol Clin Pharmacol 2022;38(3):411–416. DOI: 10.4103/joacp.JOACP_400_20.
  19. Aziz N, Khan A, Iqbal J. Subclavian vein catheterization: Supraclavicular versus infraclavicular approach. J Med Sci (Peshawar, Print) 2013;21(4):187–189. Available from: https://jmedsci.com/index.php/Jmedsci/article/view/317.
  20. Durrani HD, Butt KJ, Sadaf S, Rehan MA, Majid A, Umar A, et al. Comparison of supraclavicular versus infraclavicular subclavian venous catheterization in a tertiary care hospital. JSZMC 2013;4(3):479–482
  21. Nazir A, Niazi K, Zaidi SM, Ali M, Maqsood S, Malik J, et al. Success rate and complications of the supraclavicular approach for central venous access: A systematic review. Cureus 2022;14(4):e23781. DOI: 10.7759/cureus.23781. DOI: 10.7759/cureus.23781.
  22. Byon HJ, Lee GW, Lee JH, Park YH, Kim HS, Kim CS, et al. Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children–A randomized trial. Br J Anaesth 2013;111(5):788–792. DOI: 10.1093/bja/aet202.
  23. Sadek M, Roger C, Bastide S, Jeannes P, Solecki K, de Jong A, et al. The influence of arm positioning on ultrasonic visualization of the subclavian vein: An anatomical ultrasound study in healthy volunteers. Anesth Analg 2016;123(1):129–132. DOI: 10.1213/ANE.0000000000001327.
  24. Stachura MR, Socransky SJ, Wiss R, Betz M. A comparison of the supraclavicular and infraclavicular views for imaging the subclavian vein with ultrasound. Am J Emerg Med 2014;32(8):905–908. DOI: 10.1016/j.ajem.2014.05.001.
  25. Takhar PR, Motilal B, Savita A. Malpositioning of central venous catheter from right to left subclavian vein: A rare complication. Indian J Crit Care Med 2017;21(11):799–801. DOI: 10.4103/0972-5229.218155.
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