Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr;64(4):292-298.
doi: 10.4103/ija.IJA_930_19. Epub 2020 Mar 28.

Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance

Ram Prasad  1 , Shikha Soni  1 , Sarita Janweja  1 , Jogendra S Rajpurohit  1 , Ram Nivas  1 , Jagdish Kumar  1
Affiliations

Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance

Ram Prasad et al. Indian J Anaesth. 2020 Apr.

Abstract

Background and aims: Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications.

Settings and design: In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator.

Methods: Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups.

Statistical analysis used: Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ2 test, the Mann-Whitney U-test, Fisher's exact test and Student's t-test as appropriate.

Results: Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100% in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups.

Conclusions: Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.

Keywords: Catheterization; infection; subclavian vein; ultrasound.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
SSV probe position, USG view with Doppler profile, needle insertion and guide wire demonstration
Figure 2
Figure 2
ISV probe position, USG view with Doppler profile, needle insertion and guidewire demonstration in supraclavicular view
None
Consort Chart
Figure 3
Figure 3
Success rate and complications
Figure 4
Figure 4
Association of fever and risk factors
See this image and copyright information in PMC

References

    1. Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: The forgotten central line. West J Emerg Med. 2009;10:110–4. - PMC - PubMed
    1. Gualtieri E, Deppe SA, Sipperly ME, Thompson DR. Subclavian venous catheterization: Greater success rate for less experienced operators using ultrasound guidance. Crit Care Med. 1995;23:692–7. - PubMed
    1. Stachura MR, Socransky SJ, Wiss R, Betz M. A comparison of the supraclavicular and infraclavicular views for imaging the subclavian vein with ultrasound. AmJ Emerg Med. 2014;32:905–8. - PubMed
    1. Breschan C, Graf G, Jost R, Stettner H, Feigl G, Neuwersch S, et al. Ultrasound-guided supraclavicular cannulation of the right brachiocephalic vein in small infants: Aconsecutive, prospective case series. PaediatrAnaesth. 2015;25:943–9. - PubMed
    1. 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;36:774–8.