Supraclavicular Approach to the Subclavian Vein - One Well Forgotten Technique with Impressive Results.

Abstract

Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a "gold standard". On the other hand, the supraclavicular approach to the subclavian vein was described by Yoffa in 1965. Despite its old invention, the latter technique has been well forgotten for unknown reasons. The aim of this study is to present our experience with the usage of the supraclavicular approach for insertion of temporary and tunneled catheters as vascular access for hemodialysis treatment. We provide our experience on the insertion of 506 temporary and 501 tunneled catheters within a fiveyear period (from 1st January 2010 to 31st December 2014). We use 8 (eight) different places for catheters' insertion, including the subclavian vein via supraclavicular approach following the techniques of D. Yoffa and J. Gorchynski. The collected data include age, sex, reasons for hemodialysis, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion location. The gender distribution shows 463 (46%) women and 544 (54%) men with a median age of 60.0 (+/- 13.2) years. In the cases of temporary catheters: 104 (20.5%) are inserted in the subclavian vein via supraclavicular approach (SCVSC), 70 (13.8%) - in the internal jugular vein (IJV); in the cases of tunneled ones - SCVSC - 281 (56%), and IJV - 207 (41%) catheters, respectively. We found a significant statistical correlation (p < 0.05 and r = 0.23) between acute complications and the insertion position - AC are more for IJV insertion, than in SCVSC. We did not find a significant correlation between the insertion place and the chronic complications. Even central vein stenosis is more frequent in the IJV than in the SCVSC, but this is not significant (p > 0.05). Primary catheter patency of temporary and tunneled catheters is higher when they are inserted in the left veins. We conclude that the supraclavicular approach to the subclavian vein is an easier, safer and practically more convenient method than cannulation of the IJV. The revisit of this approach demonstrates that it should be used more widely.