Abstract
Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any.
 Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value < 0.05 was considered significant.
 Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group.
 Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.
Highlights
Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique
Central venous catheterization (CVC) is used for numerous purposes, including central venous pressure monitoring, volume resuscitation, hemodialysis access, drug administration and sampling site for repeated blood testing.[1]
Central lines can be introduced into the internal jugular, subclavian, femoral veins or from vein emerging the ante cubital fossa.[2]
Summary
Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. CVC is used for numerous purposes, including central venous pressure monitoring, volume resuscitation, hemodialysis access, drug administration and sampling site for repeated blood testing.[1] Central lines can be introduced into the internal jugular, subclavian, femoral veins or from vein emerging the ante cubital fossa.[2] SCV catheterization by infraclavicular approach and alternate supraclavicular approach has been described.[3, 4]. During cardiopulmonary cerebral resuscitation (CPCR) with SCV catheterization there is less interference in airway management.[6] Central vein catheterization should not be done in patients with coagulopathy disorder Since it increases the risk of hematoma and causes difficulty in applying pressure to subclavian artery following puncture.[7]
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