Comparison between supraclavicular and infraclavicular approaches for subclavian venous catheterization in adults

S Govindswamy,P Gowda,A M Shamanna

doi:10.4038/slja.v26i1.8269

Abstract

Introduction : The subclavian vein access has been the standard recommended approach for central venous catheterization both for short and long term use. Aim is to compare the supraclavicular and infraclavicular approaches for subclavian venous cannulation in regard to success, attempts required, time taken and complications. Material and Methods : All patients satisfying the inclusion criteria were placed either in group supraclavicular (S) or group infraclavicular (I) approach for right subclavian vein and 7FrG cannula was cannulated using modified Seldinger technique under general anaesthesia. Results: Time taken for successful cannulation in Group (S) were 188.96 ± 37.19 seconds and in Group (I) were 299.76 ± 69.712 seconds which was statistically significant with p value of st attempt, 10% in 2 nd attempt and 5% had failed cannulation. In Group (I) 67.5% were secured in 1 st attempt, 25% in 2 nd attempt and 7.5% had failed cannulation. Complications in terms of arterial puncture, malposition and pneumothorax were comparable. All these parameters were not statistically significant between the groups with p value >0.05. Supraclavicular approach is better than infraclavicular approach in terms of less mean time required for successful cannulation. Conclusion : Subclavian venous catheterization via the supraclavicular approach is aquicker method of central venous access in anesthesia.

Highlights

The subclavian vein access has been the standard recommended approach for central venous catheterization both for short and long-term use
Time taken for successful cannulation in Group S were 188.96 + 37.19seconds and in Group I were 299.76 + 69.712 seconds which was statistically significant with p value of
Our study showed that in Group S 85% of cannulas were secured in 1st attempt, 10%in 2nd attempt and 5% had failed cannulation

Summary

Introduction

The subclavian vein access has been the standard recommended approach for central venous catheterization both for short and long-term use. Received: 17/08/2017 Accepted: 20/10/2017 DDDOOOII::I:hht1tttpp0:://.//4ddoo0ii.3.oo8rrgg///11s00l..j44a00.33v882//s6slljijaa1..v.v822626ii161..988226699 having some distinct advantages over the infraclavicular approach like a well-defined insertion landmark (the clavisternomastoid angle); a shorter distance from skin to vein; a larger target area; a straighter path to the superior vena cava; less proximity to the lung and fewer complications of pleural or arterial puncture. It is less often taught and utilized for reasons that are not clear.[3,4].

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