A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach.

Abstract

The aim of this study was to compare the success rate and safety of short-axis versus long-axis approaches to ultrasound-guided subclavian vein cannulation. A total of 190 patients requiring central venous cannulation following cardiac surgery were randomized to either short-axis or long-axis ultrasound-guided cannulation of the subclavian vein. Each cannulation was performed by anesthesiologists with at least 3years' experience of ultrasound-guided central vein cannulation (>150 procedures/year, 50% short-axis and 50% long-axis). Success rate, insertion time, number of needle redirections, number of separate skin or vessel punctures, rate of mechanical complications, catheter misplacements, and incidence of central line-associated bloodstream infection were documented for each procedure. The subclavian vein was successfully cannulated in all 190 patients. The mean insertion time was significantly shorter (p=0.040) in the short-axis group (69±74s) than in the long-axis group (98±103s). The short-axis group was also associated with a higher overall success rate (96 vs. 78%, p<0.001), first-puncture success rate (86 vs. 67%, p=0.003), and first-puncture single-pass success rate (72 vs. 48%, p=0.002), and with fewer needle redirections (0.39±0.88 vs. 0.88±1.15, p=0.001), skin punctures (1.12±0.38 vs. 1.28±0.54, p=0.019), and complications (3 vs. 13%, p=0.028). The short-axis procedure for ultrasound-guided subclavian cannulation offers advantages over the long-axis approach in cardiac surgery patients.