Subclavian Vein Cannulation and its Common Technical Errors, Failure Rates and Complications: A Cross-sectional Study

Introduction: Central Venous Catheter (CVC) is indicated when peripheral vein administration is not possible which can be inserted via different routes. CVC play a significant role in the therapeutic armamentarium of the surgeon and intensivist. The subclavian vein is the most frequently used access site but is associated with certain risks and failures. Aim: To study common technical errors, failure rate and complications associated with subclavian cannulation. Materials and Methods: This was a cross-sectional observational study carried out on 100 patients admitted from October 2017 to October 2020 for various surgical diseases in a Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra, India, requiring CVC placement. Subclavian vein cannulation (SVC) technique was done as standard method. Surgeon or anaesthetist who was performing the procedure noted the number of insertion attempts, failures and complications. Data was collected and analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 and paired t-test. Level of significance was set at p-value <0.05. Results: Total of 100 patients included in the study, 57 (57%) were male with mean age of 61±14.2 years and 43 (43%) were female with mean age of 58±11.7 years. SVC was successfully done in all 100 cases but in 236 attempts. Thus, 136 attempts were failure and the overall failure rate was 57.62%. On an average there are 2.4 failed attempts per line. The most common technical error observed was improper site for needle insertion relative to the clavicle 27.94% followed by insertion of the needle through the clavicular periosteum 25.74%. The overall complication rate was 9% and most common complications was haematoma in 6%, catheter site infection 2% and pneumothorax in 1%. Conclusion: Subclavian vein catheterisation is an important invasive procedure often performed to administer drugs, haemodynamic monitoring and total parenteral nutrition. It is associated with high failure rate and complications due to technical errors of judgement leading to multiple attempts of needle insertion. They can be minimised with knowledge of anatomical landmarks, ultrasound guidance and Subclavian Vein Cannulation (SVC) personnel experience.