Comparison of a novel anterior out-of-plane approach with standard in-plane approach in ultrasound-guided supraclavicular subclavian vein cannulation: A randomised controlled trial.

Abstract

Background and aims: Subclavian vein cannulation is a commonly performed procedure in the operating room. Ultrasound-guided supraclavicular subclavian vein cannulation can be done using either an in-plane or out-of-plane approach. This study compares the in-plane technique with a novel anterior out-of-plane technique. The primary objective of the study was to compare the first-pass success rate between the anterior out-of-plane technique approach and the in-plane approach for ultrasound-guided subclavian vein cannulation.

Methods: This single-centre, open-label, randomised controlled trial included 128 patients undergoing elective surgeries that required central vein cannulation. Patients were randomised to either the anterior out-of-plane or in-plane technique for ultrasound-guided subclavian central venous access. First-pass success rates, puncture and cannulation times, needle redirections, additional punctures, and complications were recorded and compared between groups. Continuous variables were analysed using independent-sample t-tests, and categorical variables with Chi-square tests. Normality was confirmed by the Shapiro-Wilk test; P values < 0.05 were considered statistically significant.

Results: Successful cannulation was achieved in 119 patients. The first-pass success rate was significantly higher with the anterior out-of-plane approach (95%) compared to the in-plane approach (77%) (P < 0.05). The out-of-plane approach demonstrated shorter puncture [9 (SD: 3) seconds] and cannulation times [148 (SD: 31) seconds) compared to the in-plane approach [17 (SD: 9) seconds and 185 (SD: 32) seconds, respectively]. Additionally, fewer needle redirections, punctures, and complications, including arterial punctures (1 vs 5), were observed with the out-of-plane approach.

Conclusion: Ultrasound-guided supraclavicular subclavian vein cannulation is more successful and efficient using this novel anterior out-of-plane approach compared to the standard in-plane approach.