Comparison of safety and efficacy of ultrasound-guided supraclavicular and infraclavicular subclavian vein cannulation in intensive care unit patients: A randomized clinical study.

Background: The aim of this study was to evaluate and compare the ease, difficulties, and complication rate of subclavian venous catheterization using the supraclavicular (SC) and infraclavicular (IC) approach under real-time ultrasound (USG) guidance in intensive care unit (ICU). The primary objective was to compare total procedure time during USG-guided subclavian vein catheterization.

Methods: This was a prospective randomized comparative study. Eighty ICU patients of age >18 years of both genders requiring central venous catheterization were included in the study. Patients were randomly assigned to two groups using computer-generated random number table. USG guide central venous catheterization was done through SC approach in Group SC and through IC approach in Group IC after taking written consent.

Results: The total procedure time was 304.5 ± 9.35 s in Group SC compared to 389.63 ± 18.04 s in Group IC (P < 0.001). The scanning time in SC approach was 85.60 ± 10.67 s and in IC approach 95.95 ± 11.22 s (P < 0.001). The needling time in Group SC was 30.88 ± 4.37 s compared to Group IC (33.08 ± 4.24 s) (P = 0.025). The quality of needle visualization was observed better in Group SC (82.5%) compared to Group IC (47.5%) (P = 0.001). The incidence of arterial puncture (20% vs. 5%), subcutaneous emphysema (2.5% vs. none), hematoma (12.5% vs. 5%), and pneumothorax (7.5% vs. none) has been observed in Group IC versus Group SC, respectively (P > 0.05).

Conclusion: USG-guided SC approach of subclavian vein catheterization has shorter procedural time with better needle visualization and less complication rates than the IC approach.