Abstract
Introduction: Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. The aim of this study was to evaluate influence of arm position during infraclavicular subclavian vein catheterization with landmark-based technique in coronary artery bypass graft (CABG) surgery. Methods: Between September 2017 and June 2018, this prospective randomized clinical trial was performed in 320 patients. The patients were randomly assigned to the Neutral group (the arms kept by the side) or Abduction group (the arm was abducted to 90°). The success and complication rates were compared in the two groups. The data were analyzed using SPSS software. Results: In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). The overall success rate in two attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral group. There was a significant difference between two groups in the second and overall success rates (P = 0.0001). In 34 (10.6%) patients, subclavian artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%) in the Neutral group. There was a significant difference between two groups (P = 0.0001). Pneumothorax was occurred in 15 (9.4%) in the Abduction group and 3 (1.9%) in the Neutral group. There was also a significant difference between two groups (P = 0.004). The differences in other complications on two groups were statistically insignificant. Conclusion: Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. The incidences of other complications were similar on both groups.
Highlights
Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein
In the first attempt of subclavian vein cannulation, the success rate had no significant difference between two groups (P = 0.185)
In the NE group, five catheter tips were placed in the right internal jugular vein and in two, the catheter tip was placed in the contralateral subclavian vein
Summary
Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. Results: In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). Conclusion: Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. Some of the physicians believe internal jugular vein catheterization is better than subclavian vein catheterization owing to a lower risk of pneumothorax and a high success rate of cannulation, accidental carotid artery puncture in these high-risk atherosclerotic patients is a serious complication.
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