A Comparative Study of Complications in Ultrasound-Guided Central Venous Catheterization (Internal Jugular Vein Versus Subclavian Vein): A Prospective, Randomized, Multicenter Trial

Abstract

Background: The use of ultrasound (US) has been suggested to reduce complications of central venous (CV) catheterization and to increase the safety and quality of CV catheter placement. However, complication rates have not been compared according to insertion points for CV catheterization using US. Accordingly, this study aimed to compare the complication rates of internal jugular vein (IJV) with those of subclavian vein (SCV) catheterization. Methods: A total of 1484 patients were preoperatively randomized into two groups. The internal jugular (IJ) group (n = 742) was cannulated via the right IJV, and the subclavian (SC) group (n = 742) was cannulated via the right SCV under US guidance. The primary outcome measure was total complication rate. Secondary outcomes included access time for the first attempt, number of attempts, and catheter position. Findings: The total complication rate did not demonstrate a significant difference between the IJ (0*1%) and SC (0*7%) groups (P = 0*248). In the IJ group, arterial puncture occurred in 0*1% of patients; in the SC group, arterial puncture occurred in 0*6% and pneumothorax in 0*1%. The access time for the first attempt (P < 0*001) and the average number of attempts were significantly lower (P = 0*006) in the IJ group than in the SC group. More catheter misplacements were observed in the SC group (5*9%) than in the IJ group (0.4%) (P < 0*001). Interpretation: Results demonstrated that complication rates in IJV and SCV catheterization using US are very low and are comparable. Clinical Trial Number: This trial is registered with ClnicalTrials.gov, number NCT01510743. Funding Statement: The authors report: There is no funding source. Declaration of Interests: All authors report no conflict of interest. Ethics Approval Statement: Institutional review board approval was obtained from the following centers: Seoul National University Bundang Hospital (Gyeonggi, Korea), Asan Medical Center (Seoul, Korea), and Boramae Medical Center (Seoul, Korea). Informed written consent was obtained from all patients before participation.