Seeing Artery and VEin Simultaneously in the long axis (SAVES) for ultrasound-guided infraclavicular axillary/subclavian vein cannulation: A retrospective analysis

Background

The anatomical configuration of the anterior scalene muscle, inserting between the subclavian vein and artery, creates a space between them. By placing an ultrasound probe in the infraclavicular area, an optimal longitudinal view of both the proximal part of the axillary and the distal part of the subclavian vein and artery can be obtained, while the pleura is out of view. This Seeing Artery and VEin Simultaneously in the long axis (SAVES) method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation offers theoretical advantages because it may avoid iatrogenic pneumothorax and reduce the risk of arterial damage. The objective of the present study was, to our knowledge, for the first time, to determine the safety and efficacy of the SAVES method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation in adult critically ill patients.

Methods

A retrospective study was performed on consecutive adult critically ill patients who underwent ultrasound-guided infraclavicular axillary/subclavian vein cannulation performed by the same physician in a medical/surgical intensive care unit (12 beds) between 20 August 2021 and 20 December 2024. The overall success rate, the first-pass success rate, the access time and number of attempts, the incidence of difficulty with insertion of the guidewire/dilator/catheter, and the mechanical complication rate were analyzed.

Results

A total of 111 adult critically ill patients required 142 ultrasound-guided infraclavicular axillary/subclavian vein punctures using the SAVES method. The overall success rate was 100%, and the first-pass success rate was 75.4%. The access time was 38.5 (interquartile range: 21.5–80.0) s. The proportions of different numbers (1, 2, and 3) of attempted catheterizations were 88.7%, 9.2%, and 2.1%, respectively. The incidence of difficulty with guidewire insertion was 15.5%, while no difficulty with insertion of the dilator or catheter was experienced. No instance of pneumothorax, hemothorax, arterial puncture, brachial plexus injury, or cardiac tamponade was recorded. The incidence of hematoma formation was 2.1%. The occurrence rate of posterior venous wall penetration was 3.5%. The catheter malposition rate was 5.6%.

Conclusions

The SAVES technique may be a safe and effective approach for ultrasound-guided infraclavicular axillary/subclavian vein cannulation. A larger controlled prospective study is warranted to confirm these findings.