Apprentissage du cathétérisme de la veine sous-clavière chez l’adulte : apport de l’assistance échographique en temps réel

Abstract

Objective: To assess the training in adult subclavian venous catheterization of an inexperienced operator, with two different procedures: ultrasound guidance vs anatomic landmark technique. Study design: Prospective, comparative study. Patients and methods: After informed consent, 50 adults were divided in two groups, with an original method of inclusion, designed to assess the training of the operator, which alternated ultrasound guidance ( n = 25) and Aubaniac’s landmark technique ( n = 25). Results: All the catheterizations have been completed. The success rate at first attempt was higher in ultrasound group than in landmark group, without reaching significance (76 vs 56 %). Two arterial punctures were reported in landmark group. With ultrasound guidance, there were 21 puncture sites at the external third and 4 at the medial third of the clavicle. Average access time (skin to vein) was 15 ± 8 seconds in ultrasound group and 63 ± 78 seconds in landmark group ( p < 0.01), with a significant relation between access time and patient rank in landmark group ( r 2 = 0.42, p < 0.01). Conclusion: Ultrasound guidance makes the training in adult subclavian venous catheterization easier, and allows inexperimented operator to be rapidly efficient. The use of ultrasound would decrease the incidence of complications by a real time visualization of anatomical structures, and by a more external approach of the vein than in the Aubaniac's technique.