Subclavian Vein Catheterization Research Articles

Minimally invasive approach to managing brachiocephalic trunk cannulation complicating central venous catheterization: a case report

BackgroundCentral venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.Case presentationA 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient’s vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient’s continued stability.ConclusionThis case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure’s accuracy and safety.

Effects of improved right subclavian vein catheterization on the direction of the catheter tip in children

Background. Catheter tip malposition is commonly observed during subclavian vein catheterization. This study was to investigate whether position and partially retracted the guide wire could reduce catheter malposition. Methods. The children needing right subclavian venipuncture catheterization were randomly divided into two groups: test group A (82 patients) and control group B (82 patients). In group A, catheterization was performed with the patient in a supine position and the guide wire partially retracted during placement. In contrast, in group B, catheterization was done with the patient in Trendelenburg without partial retraction of the guide wire. The catheter tip direction was examined using intraoperative ultrasound, and a postoperative chest X-ray was obtained. Results. The rate of correct catheter tip direction at first insertion was higher in group A compared to group B (86.2% vs. 66.7%, P < 0.05). There were no significant differences in incidence and general data between the two groups. The repeated vascular puncture was unsuccessful in three patients (2 cases in group A and 1 case in group B), and right internal jugular vein catheter instead. Conclusions. The guide wire can be partially retracted in the supine position to reduce catheter tip malposition during right subclavian venipuncture in children.

Ultrasound-Guided Subclavian Vein Catheterization: Contrasting Supraclavicular and Infraclavicular Approaches for Enhanced Procedural Precision.

Background Ultrasound-guided subclavian vein catheterization is crucial for central venous access, but the choice between the supraclavicular and infraclavicular approaches lacks comprehensive comparison. This study addresses this gap by conducting a prospective observational analysis of both techniques. The supraclavicular method accesses the vein from above the clavicle while the infraclavicular targets it below. Our model-driven approach aims to elucidate the procedural nuances, success rates, and complications associated with each method. The findings intend to equip clinicians with evidence-based insights, facilitating informed decision-making for improved procedural outcomes in ultrasound-guided subclavian vein catheterization. Aim and objective This study aims to comprehensively compare the supraclavicular and infraclavicular approaches in ultrasound-guided subclavian vein catheterization, evaluating the procedural minutiae, potential advantages, and challenges associated with each technique. Employing a prospective observational methodology, our objective is to provide evidence-based insights for approaches in ultrasound-guided subclavian vein catheterization, evaluating procedural nuances, success rates, and complications during the procedure. Methods In this prospective investigation, 276 patients aged between 20 and 55 years were randomly assigned to two groups: 143 patients in the supraclavicular group and 133 patients in the infraclavicular group. Specifically, patients admitted for elective surgery necessitating postoperative ICU care were considered. The study assessed various variables, including success rate, time required for venous visualization, venous puncture, catheterization, total procedure duration, and incidence of mechanical complications, to facilitate group comparisons. Results The mean procedural time was shorter in the supraclavicular group compared to the infraclavicular group, with durations of 2 minutes and 2 seconds versus 3 minutes and 40 seconds, respectively (95% CI). This difference was statistically significant. Similarly, the mean durations for venous visualization, venous puncture, and venous catheterization were also shorter in the supraclavicular group, and these differences were statistically significant. Both groups achieved a 100% success rate, with the first attempt success rate being higher in the supraclavicular subclavian vein group. Conclusion The findings of this study demonstrate a statistically significant advantage in favor of the supraclavicular approach for ultrasound-guided subclavian vein catheterization. The shorter mean procedural time, as well as durations for venous visualization, puncture, and catheterization, emphasize the efficiency of the supraclavicular technique. The consistently achieved 100% success rate, coupled with a higher first-attempt success rate, further underscores the proficiency of the supraclavicular subclavian vein group. These results collectively suggest that the supraclavicular approach is not only time-efficient but also superior in terms of successful central line placement, making it a promising choice for both emergency and critical care settings.

An innovative method to prevent guidewire access to the ipsilateral internal jugular vein during pediatric subclavian vein cannulation

ObjectivesCatheter misplacement into the internal jugular vein (IJV) often occurs during pediatric subclavian vein (SCV) catheter placement. The aim of this study was to investigate whether an innovative method of occluding the IJV by applying temporary pressure at the IJV just above the clavicle could help prevent its occurrence. DesignThis is a randomized controlled trial. SettingsThis study was conducted in a single medical center. ParticipantsOne hundred and seventy-eight children undergoing SCV catheterization were recruited. InterventionsChildren were randomly assigned to the traditional group (unassisted placement of the guidewire) and the innovative group (temporary pressure on the IJV just above the clavicle to occlude the IJV during placement of the guidewire). Measurements and Main ResultsThe primary outcome was the incidence of guidewire misplacement into the IJV at the time of first placement. Secondary outcomes included the total number of attempts and the total time of guidewire placement. The incidence of misplacement at the first attempts was reduced from 18.06% in group C to 6.67% in group I (P=0.04). The total number of guidewire entered the IJV in group I was less than in group C [group C vs. group I = 24/96 vs. 7/82, P=0.005]; the total time of guidewire placement was reduced from 35.00s (18.25s, 54.00s) in group C to 26.00s (17.00s, 38.00s) in group I, (P=0.03). ConclusionsTemporary pressure at the IJV just above the clavicle to occlude the IJV during placement of the guidewire helps prevent inadvertent placement of the guidewire into the IJV.

Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial.

The subclavian vein is frequently cannulated using ultrasound. There are two techniques of subclavian vein catheterization (SVC): Supraclavicular (SC) and infraclavicular (IC). Though the IC route is often preferred, the SC approach offers several distinct advantages. This study was planned to compare the technique of SVC using SC and IC approaches in terms of catheterization technique and complications in elective surgeries in adults. Sixty American Society of Anesthesiologists (ASA) 1, 2, or 3 adult patients posted for elective surgeries under general anesthesia were recruited. Patients were divided into SC or IC groups randomly. Right-sided subclavian vein was cannulated in both the groups (n = 30). Visualization time, Likert scale, subclavian vein diameter, skin-to-subclavian vein depth, number of attempts, puncture time, ease of guidewire insertion, catheter insertion time, and total procedural time were observed. A comparison of complications for each approach was noted. Total procedural time, time to visualization of the subclavian vein, and puncture time was lower for group SC and higher for group IC. Catheter insertion time was higher with the IC approach than with the SC approach. Better ultrasound view scores were seen in group SC than in group IC. The first attempt success rate was higher in group SC than in group IC. Comparatively, lower complications both during and after the procedure were noted in the SC approach than the IC approach. Ultrasonography (USG) guidance guided SC approach to access the subclavian vein is quicker, relatively secure, and a better technique than the IC approach. Additionally, the SC approach is associated with comparatively fewer immediate and delayed complications. Jaiswal P, Saini S, Chhabra PH. Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial. Indian J Crit Care Med 2024;28(4):375-380.

Mid-term analysis of prospective cohort study of rivaroxaban in preventing CRT in breast cancer

Objective: To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies. Methods: In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT. Results: In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant (P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively (OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions: In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.

Comparison of ultrasound guided supraclavicular subclavian vein versus infraclavicular subclavian/axillary vein catheterization: A systematic review and meta analysis.

Subclavian vein cannulation is an important technique of central venous cannulation with a supraclavicular and an infraclavicular approach. There are randomized controlled trials (RCTs) which highlight the various differences between these two approaches when accessed via ultrasound. We undertook a meta-analysis to compare the ultrasound guided supraclavicular subclavian and the infraclavicular subclavian/axillary vein cannulation, keeping in mind that the infraclavicular approach may lead to cannulation of either subclavian/axillary vein. This meta-analysis encompassed studies that compared ultrasound-guided supraclavicular subclavian vein and infraclavicular subclavian/axillary vein. Binary outcomes were presented as odds ratios (OR), while continuous outcomes were presented as standardized mean differences (SMD) accompanied by 95% confidence intervals (95% CI). Potential trials meeting the eligibility criteria were sought from databases including PubMed, PubMed Central, The Cochrane Library, and EMBASE, covering the period from inception to April 30, 2023. The analysis comprised a total of six randomized controlled trials (RCTs) and one retrospective observational study collectively involving 1812 patients. The first pass success rate for subclavian vein catheterization was found to be greater with the supraclavicular approach (OR = 1.91 [95% CI 1.04-3.50]; p = 0.0002; I2 = 77%). Moreover, the supraclavicular approach exhibited a significantly shorter catheterization time compared to the infraclavicular approach (SMD = -0.26 [95% CI -0.54 to 0.03]; p = 0.003; I2 = 73%). Notably, there was no substantial disparity in complication rates between the two approaches (OR = 0.66 [95% CI 0.35-1.24]; p = 0.20; I2 = 0%). Ultrasound-guided supraclavicular approach for subclavian vein catheterization is superior to the infraclavicular approach for subclavian/axillary vein catheterization, with higher first-pass success rates, shorter catheterization times. However, there were no differences in the complication rates.

Comparison of the Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Vein Cannulation in Children With Congenital Heart Disease

Objective(s)Central venous catheterization (CVC) is widely used in pediatric critical patients. We thought to compare the success rate and safety of ultrasound-guided subclavian vein cannulation performed via infraclavicular and supraclavicular approaches. DesignWe compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease (CHD) requiring central venous catheterization who were randomly assigned to the supraclavicular approach group (Group A) or infraclavicular approach group (Group B). SettingMedical university hospital pediatric cardiac intensive care units (CICUs). ParticipantsPediatric patients diagnosed with CHD in the preoperative period who were admitted to the CICU and required subclavian vein catheterization. InterventionsUltrasound-guided subclavian vein cannulation. Measurements & Main ResultsSixty-seven children were included in the study, with 32 in Group A and 35 in Group B. Notably, there was a significant difference in the success rate of the first puncture between Groups A and B (90.6% vs. 71.4, %, p = 0.047). Furthermore, the access time in Group A was 11.8 (3.2–95) seconds, which was significantly shorter than that in Group B (16.0 [6.5–227] seconds, p = 0.001). In addition, the catheter malposition rate in Group A was significantly lower than that in Group B (0% vs. 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (e.g., pneumothorax, hemorrhage, puncture artery, and nerve injury) between the two groups. ConclusionsFor children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and the trend of lower incidence of catheter malposition. However, a larger sample size of randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.

A modified technique of subclavian vein catheterisation: Remembering Sedillot.

A modified technique of subclavian vein catheterisation: Remembering Sedillot.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition for CME Credit December 2023

Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition for CME Credit December 2023

Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study

IntroductionCentral venous catheters are indispensable in modern healthcare. Unfortunately, they are accompanied by minor as well as major complications, leading to increased morbidity, mortality and costs. Immediate insertion-related complications (mechanical...

Comparison between supraclavicular and infraclavicular approaches for ultrasound-guided right subclavian venous catheterization in major elective surgeries and ICU patients

Background Central venous catheterization is an important device that is frequently performed for various purposes in operating theatres and intensive care units, there are many different sites that are commonly used for central venous catheterization, and each site has its own advantages, disadvantages, and possible complications. To avoid catheterization failure and mechanical complications, ultrasound guidance is currently recommended in several guidelines and is widely used for central venous catheterization. It has been shown to reduce the incidence of arterial puncture, hematoma formation, pneumothorax, hemothorax, and catheterization failure. The subclavian vein (SCV) catheterization is more comfortable for patients than other sites but has a higher risk of some complication as pneumothorax. The aim of this study was to compare the Supraclavicular and Infraclavicular approaches for ultrasonographic guided right subclavian venous catheterization as regard the accessibility and the safety of both approaches. Methods This randomized controlled study was conducted in Sohag University Hospital after local ethical committee approval, 210 patients had a right subclavian vein catheterization by either the supraclavicular or the infraclavicular approach (105 for each group), using a two dimensional high-frequency ultrasound guide were enrolled in the study regarding the accessibility (time to first puncture and number of punctures) and the complications like arterial puncture, hematoma formation, arrhythmia, and catheter misplacement. Results The infraclavicular approach is more accessible, regarding the number of punctures, for the Supraclavicular approach there were 56 (53.3%) cases needed only one puncture to achieve successful venous puncture and 27 (25.7%) cases needed 2 punctures and 5 (4.8%) needed 3 punctures and 17 (16.2%) failed in catheterization, for the Infraclavicular approach there were 79 (75.2%) of cases in these group needed only one puncture to achieve successful venous puncture and 17 (16.2%) cases needed 2 punctures and 9 (8.6%) failed in catheterization with a significant difference between both groups P value was 0.003. As regard the puncture time, for the Supraclavicular approach 83 (79%) cases successes in less than 3 min, and 22 (21%) cases needed more than 3 min, in the infraclavicular approach 94 (89.5%) cases succeeded in less than 3 min and 11 (10.5%) cases needed more than 3 min at P value 0.037 and had a lower rate of complications than the supraclavicular approach, like arrhythmia, arterial puncture, hematoma formation, catheter misplacement, and postcatheterization infection, but a higher rate of pneumothorax formation however in a nonsignificant way. Conclusion The infraclavicular approach for ultrasound-guided right subclavian venous catheterization is better than the supraclavicular approach due to a higher chance of first pass success rate and a lower rate of complications.

Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia.

Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation. Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Randomized comparative study. After approval from Institutional Review Board and Ethical Committee, 100 patients of 18-70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique. First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group. For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position.

Assessing the educational value and content of YouTube videos for ultrasound-guided subclavian vein catheterization.

The European Society of Anaesthesiology (ESA) published a guideline regarding continuous ultrasound guidance for central venous catheters in 2020. YouTube has been a popular educational platform since its inception. The purpose of the present study was to evaluate the adequacy of videos on ultrasound-guided subclavian vein catheterization posted on YouTube based on this guideline. YouTube was scanned using the keywords associated with ultrasound-guided subclavian vein catheterization and 46 of the 106 most-watched videos were included in the study. The videos were divided into three groups, as individual, manufacturer, and academic according to their sources, and were evaluated as poor, satisfactory, and good in terms of the overall content. The videos were then evaluated based on ESA's six-title guide for more specific informational content. A total of 46 videos were reviewed and 52.2% (n = 24) were found to be prepared by individuals. Among the videos, the rate of videos describing only venipuncture (poor) was 23.9% (n = 11), 73.9% (n = 34) of videos described the verification of the guidewire location with venipuncture, and 2.2% of videos described all the recommendations suggested by the guide (n = 1). At the end of the catheterization procedure, 4.3% (n = 2) stated that the catheter location should be confirmed by using ultrasound, 15.2% (n = 7) recommended chest-X-ray, and 80.4% (n = 37) did not suggest any. Manufacturer and academic videos can be watched due to their high-quality scores, but it may be practical to prepare training videos with guidelines both for educators and students to have global access to the renewed guideline information.

Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials.

Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclear in the previous systematic review. This updated review is designed to search the efficacy and safety of both approaches adopting the Grading of Recommendations Assessment, Development and Evaluation approach. In May 2022, we explored the databases of Embase, MEDLINE, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomised controlled trials to compare the two approaches. Seventeen trials (2482 cases) were included. In the primary outcomes, the SC approach likely reduces the failure proportion (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47-0.86; I2 = 5%) and the incidence of malposition (RR, 0.23; 95% CI, 0.13-0.39; I2 = 0%) with moderate evidence and may slightly reduce the incidence of arterial puncture and pneumothorax (RR, 0.59; 95% CI, 0.29-1.22; I2 = 0%) with low evidence. In the secondary outcomes, the SC approach may decrease the access time and may increase the first-attempt success proportion. The SC approach for SVC should be selected after considering the clinician's expertise.

Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter: study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial

BackgroundThe right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes.MethodsAdult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients’ experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard.DiscussionThe use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations.Trial registrationClinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.

Real-time ultrasound-guided versus landmark-guided subclavian vein catheterization in the intensive care unit: a prospective randomized study

Abstract Background The subclavian vein (SCV) is an alternative to the internal jugular vein when it is difficult to locate, such as in patients with hypovolemia or obesity. Ultrasonography (USG) guidance for SVC cannulation has evolved, resulting in fewer complications and higher first-pass success rates. This study aimed to compare the effectiveness and safety of SCV cannulation with USG- and landmark-guided techniques. Methods In this prospective randomized interventional controlled study, 80 patients admitted to the intensive care unit between July 2022 and October 2022 were randomly assigned to the landmark method group (LM group) and USG group. In the LM group, SCV cannulation was performed using the traditional landmark technique, whereas in the USG group, it was performed using USG guidance. The primary objective of this study was to evaluate the ease of subclavian central venous cannulation in critically ill patients using the 2 techniques. The secondary objectives were to compare the success rate of cannulation between these 2 techniques, evaluate the number of attempts, assess cannulation failure, and assess mechanical complications. Results The first-pass success rates were 70% and 92.5% in the LM and USG groups, respectively (P < 0.001). The average numbers of attempts in the LM and USG groups were 1.275 (±0.520) and 1.075 (±0.266), respectively (P = 0.034). The average procedure durations were 7.45 (±1.10) and 8 (±0.933) minutes in the LM and USG groups (P = 0.018), respectively. The rates of complications in both groups were not statistically significant. Conclusion The USG guidance for SCV cannulation has an advantage over landmark-guided methods in a critical care setting. The SCV is a good alternative to internal jugular vein cannulation. The average time to cannulation was longer in the USG group than in the LM group, which can decrease with the frequent use of USG and increasing operator experience. Clinical trials This study was registered in the Clinical Trials Registry-India (CTRI Trial No. CTRI/2022/07/043694, dated May 7, 2022).

Case report of a stuck hemodialysis central venous catheter: from endovascular intervention to median sternotomy

Background: Extended uses of hemodialysis catheters is often associated with thrombosis and fibrosis of the central vein around the catheter. The removal becomes complex when the catheter is stuck in a central vein. This case report presented a complex stage of removing a stuck catheter in the central vein. Case Report: A 45-year-old man complained of a stuck hemodialysis catheter in the left subclavian vein, which had been placed 8 months previously. An endovascular intervention has been tried using traction and snaring of the catheter tip, but it cannot be removed because the body part of the catheter is firmly attached to the central vein, so we decided to evacuate the catheter using the median sternotomy procedure. We found an adhesion between the left innominate vein's wall and the catheter's body about 4 cm from the catheter tip. The left innominate vein was incised longitudinally while detaching the catheter against the vein. We repair the left Innominate vein without using a graft. Conclusion: A stuck catheter to the central vein was an unexpected complication due to the removal of the hemodialysis catheter. There are several options for removing a stuck catheter, such as various endovascular interventions and open surgical techniques.

Lung deflation while placing a subclavian vein catheter: Our experience in minimizing the risk of pneumothorax.

Lung deflation may reduce the risk of pneumothorax based on the assumption that the distance between the subclavian vein and the lung pleura would increase as well as the diameter of the vein. We aim to provide evidence to support the suggested desideratum of deflation in adults. A prospective database was created that included patients who underwent subclavian vein catheterization for monitoring and therapeutic reasons from January 2014 to January 2020. Measurements using ultrasonography of the diameter of the subclavian vein were taken while the patient's breathing was controlled by a ventilator and then repeated after disconnecting the mechanical ventilation and opening the pressure relief valve. A total of 123 patients were enrolled, with an average age of 41.9 years. The subclavian vein diameter was measured during controlled breathing with a mean average of 8.1 ± 0.6mm in males and 7.1 ± 0.5mm in females. The average increase after lung deflation with the pressure relief valve closed was 8.0± 5.1mm in males and 13.9 ± 5.4mm in females. An increase was noticed after opening a pressure valve, and the means were 5.5 ± 2.8mm in males and 5.1 ± 3.3mm in females. The catheter malposition rate was 0.8. The benefit of interrupting mechanical ventilation and lung deflation lies within possibly avoiding pneumothorax as a complication of subclavian vein catheterization. These findings support the need for evidence regarding the curtailment of pneumothorax incidence in spontaneously breathing patients and the suggested increase in first-time punctures and success rates.