Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital

Anna Sidoti,Gregorio Santori,Lara Tollapi,Matteo Borselli,Paolo Malacarne,Fabio Guarracino,Francesco Forfori,Etrusca Brogi,Francesco Corradi,Giandomenico Biancofiore,Sergio Casagli

doi:10.1038/s41598-019-48766-1

Abstract

This was a single-center, observational, prospective study designed to compare the effectiveness of a real-time, ultrasound- with landmark-guided technique for subclavian vein cannulation. Two groups of 74 consecutive patients each underwent subclavian vein catheterization. One group included patients from intensive care unit, studied by using an ultrasound-guided technique. The other group included patients from surgery or emergency units, studied by using a landmark technique. The primary outcome for comparison between techniques was the success rate of catheterization. Secondary outcomes were the number of attempts, cannulation failure, and mechanical complications. Although there was no difference in total success rate between ultrasound-guided and landmark groups (71 vs. 68, p = 0.464), the ultrasound-guided technique was more frequently successful at first attempt (64 vs. 30, p < 0.001) and required less attempts (1 to 2 vs. 1 to 6, p < 0.001) than landmark technique. Moreover, the ultrasound-guided technique was associated with less complications (2 vs. 13, p < 0.001), interruptions of mechanical ventilation (1 vs. 57, p < 0.001), and post-procedure chest X-ray (43 vs. 62, p = 0.001). In comparison with landmark-guided technique, the use of an ultrasound-guided technique for subclavian catheterization offers advantages in terms of reduced number of attempts and complications.

Highlights

The role of ultrasound (US) for IJV catheterization has been accepted as the standard of care after the recommendations by National Institute for Health and Clinical Excellence (NICE) in 2002, but the same guidelines stated that there was insufficient evidence to support the use of US for SCV catheterization
After long-standing experience with US-guided IJV and femoral vein cannulation, we have extended this technique to SCV cannulation with encouraging results
Our analysis demonstrated that US guidance significantly reduced the adverse events of SCV cannulation, though the overall success rate was not significantly different from landmark technique

Summary

Introduction

The role of ultrasound (US) for IJV catheterization has been accepted as the standard of care after the recommendations by National Institute for Health and Clinical Excellence (NICE) in 2002, but the same guidelines stated that there was insufficient evidence to support the use of US for SCV catheterization. A Cochrane systematic review published in 2015 concluded that “two-dimensional US offers small advantages in terms of safety and quality in comparison with an anatomical landmark technique for either subclavian or femoral vein cannulation”[8]. After long-standing experience with US-guided IJV and femoral vein cannulation, we have extended this technique to SCV cannulation with encouraging results. Were to compare, in two groups of adult patients, the effectiveness and safety of SCV cannulation with US- or landmark-guided technique

Methods

Results

Discussion

Conclusion