Subclavian Venous Catheter Research Articles

Comparison of Catheter Malposition Between Left and Right Ultrasound-Guided Infraclavicular Subclavian Venous Catheterizations: A Randomized Controlled Trial.

Catheter malposition after subclavian venous catheterization (SVC) is not uncommon and can lead to serious complications. This study hypothesized that the left access is superior to the right access in terms of catheter malposition after ultrasound-guided infraclavicular SVC due to the asymmetry of the bilateral brachiocephalic veins. Parallel-armed randomized controlled trial. A tertiary referral hospital in Korea. Patients 20-79 years old who were scheduled to undergo SVC under general anesthesia. Patients were randomly assigned to either the left ( n = 224) or right ( n = 225) SVC group. The primary outcome measure was the overall catheter malposition rate. The secondary outcome measures included catheter malposition rates into the ipsilateral internal jugular and contralateral brachiocephalic veins, other catheterization-related complications, and catheterization performance. The catheter malposition rate was lower (10 [4.5%] vs. 31 [13.8%], p = 0.001), especially in the ipsilateral internal jugular vein (9 [4.0%] vs. 24 [10.7%], p = 0.007), in the left SVC group than in the right SVC group. In the left SVC group, catheterization success rates on the first pass (88 [39.3%] vs. 65 [28.9%], p = 0.020) and first-catheterization attempt (198 [88.4%] vs. 181 [80.4%], p = 0.020) were higher whereas times for vein visualization (30 s [18-50] vs. 20 s [13-38], p < 0.001) and total catheterization (134 s [113-182] vs. 132 s [103-170], p = 0.034) were longer. There were no significant differences in other catheterization performance and catheterization-related complications between the two groups. These findings strengthen the rationale for choosing the left access over the right access for ultrasound-guided infraclavicular SVC.

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.

Surgical Removal of an Extravascular Knotted J-Tip Guidewire During Subclavian Central Venous Catheterization- A Case Report

Guidewire-related complications during central venous catheterization are relatively uncommon. However, they can still occur even with experienced physicians. This report presents a case of an extravascular knotted guidewire during central venous catheterization that required surgical removal. A 72-year-old male patient scheduled for cervical anterior interbody fusion surgery underwent left subclavian venous catheterization one day before the surgery. The J-tip guidewire was inserted through the introducer needle easily without any resistance. During the insertion of the catheter over the guidewire, the catheter did not advance more than 3 cm from the skin. The guidewire was kinked, which was further aggravated by attempts to remove it forcefully, leading to a knot formation that required surgical removal. The patient was discharged one week after the surgery without any additional complications. Safe removal of guidewires is of utmost importance, and preventive measures should be taken to reduce the risk of complications.

Spontaneous Catheter Fracture with Embolization: A rare complication of Totally Implantable Subclavian Venous Catheter

Totally Implantable venous access insertion has become routinely involved in the treatment of patients in oncology, However, certain complications are associated with the use of these devices: catheter migration with embolization, pinch-off sign. We report a case of successful extraction of an embolized distal portion of the Catheter from left pulmonary artery.

Subclavian venous catheterization: focused on the procedure

Central venous catheterization is a typical technique performed in the emergency department and intensive care unit. Most subclavian vein access may be inserted without help, using anatomic landmarks alone. This study aimed to present the precise procedure of central venous catheterization via the subclavian vein and endovascular techniques using a simulation video clip.

A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature.

In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.

Comparative evaluation of ultrasound guided supraclavicular and infraclavicular subclavian venous catheterizations in adult patients.

Ultrasound-guided subclavian vein cannulation has two approaches: supraclavicular and infraclavicular. The aim of this study was to compare the ease of cannulation by recording the puncture time of the subclavian vein with the two approaches in adult patients. This study was approved by our institutional ethics committee, and a written informed consent was obtained from the patients. This prospective randomized trial recruited patients aged 18 to 80 years with definite indications of subclavian vein cannulation. Real-time in-plane ultrasound-guided technique was used, and the subclavian vein was punctured at the junction of the brachiocephalic and IJV in supraclavicular approach (SC) and in oblique axis below the border of the clavicle in infraclavicular approach (IC). A total of 96 patients were randomly allocated equally into two groups of 48 each, but only 45 patients in each group could be successfully cannulated. Median puncture times were comparable; 15 (9-39) s in SC and 21 (5-80) s in IC group. The first attempt success rate was 82.2% and 62.2%, and the mean total access time was 99.11 ± 34.66 s and 103.44 ± 50.27 s in SC and IC approaches, respectively and were comparable. The attempts of needle puncture were significantly higher in IC approach (1.40 ± 0.54 vs 1.20 ± 0.46 in SC approach; P = 0.04). The complication rates were comparable and less than 5%. Ease of cannulation of the subclavian vein using ultrasound-guided supraclavicular and infraclavicular approach is comparable as no statistically significant difference is noted in the puncture time and first-attempt success rate. The increased number of needle punctures reported in our study with the IC approach did not translate to an increased complication rate.

NEEDLE–TISSUE INTERACTION MODEL AND EXPERIMENTAL STUDY OF SUBCLAVIAN VEIN PUNCTURE

The subclavian venous puncture catheter has been widely used in treatment of critically ill patients. However, the lack of a mechanical model for subclavian vein puncture and selection of puncture parameters lead to procedure failures. This paper develops a puncture force model, and explores the factors affecting puncture force through a series of experiments. The puncture process is divided into four stages, and a mechanical model is established for each stage. The parameters of the puncture model, including the needle insertion angle and diameter, and venous pressure, are analyzed experimentally using biological tissues. The Box–Behnken experiment design is chosen to account for the cross-interactions of the various factors considered.

Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: a randomised controlled non-inferiority trial.

Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non-inferior to the infraclavicular approach in terms of safety during ultrasound-guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound-guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. We assessed catheterisation-related complications (primary outcome measure) including catheter misplacement and mechanical complications (arterial puncture, haematoma formation, pneumothorax and haemothorax). We also recorded catheterisation success rates and time required for venous puncture and catheterisation. The number (proportion) of patients with catheterisation-related complications was six (3.0%) in the supraclavicular group and 27 (13.4%) in the infraclavicular group, mean difference (95%CI) -10.4% (-15.7 to -5.1%), p < 0.001, with a significant difference also seen for catheter misplacement. Except for a shorter time (median (IQR [range]) required for venous puncture in the supraclavicular group, being 9 (6-20 [2-138]) vs. 13 (8-20 [3-99]) s, the incidence of mechanical complications and other catheterisation characteristics were similar between the two groups. We recommend the supraclavicular approach for ultrasound-guided right subclavian venous catheterisation.

A Formation of a true knot in subclavian venous catheter in a patient in the intensive care unit

Vascular catheters installation is most frequently used in critical care units. A node in the catheter lumen is a rare mechanical complication of the central venous catheterization. The 14-year-old was treated for acute appendicitis complicated by diffuse purulent peritonitis. It was decided to install a central venous catheter on the very first day of treatment. A catheterization of the right subclavian vein according to Seldinger was carried out. The catheter functioned properly for 6 days. On the 7th day, in the process of removal of the catheter, its extraction was blocked at a 1 cm depth from the tip. The catheter was removed by strong physical force with the occurrence of a hematoma in the area of installation of the catheter. Once removed, on the catheter there was found a node, formed inside the vessel. In this case, no disabling and life-threatening complications as a result of the use of the catheter were recorded. In the future, the patient was discharged recovered.

A study to compare effects of shoulder position on infraclavicular central venous catheterization in critically ill patients.

Objectives: Aim of this study was to compare the effects of two different shoulder positions on infraclavicular subclavian venous catheterization in critically ill patients. Study Design: Prospective Comparative study. Setting: Sheikh Zayed Medical College Rahim Yar Khan Pakistan. Period: 1st July 2017 to 30th June 2018. Material &amp; Methods: Enrolling 100 patients thru convenient sampling, divided into two groups, Group A &amp; Group B, 50 in each group. In group A patients were put in supine position, with head turned to contra lateral side and caudal pull was applied on ipsilateral shoulder. While in group B patients were lying supine, head turned to contra lateral side and shoulders were retracted by placing a small pillow vertically under the chest between the scapulae. In both groups, subclavian vein was approached through infra clavicular route. Number of attempts of venous punctures (1st attempt / 2nd attempt), total time spent on procedure (from 1st skin puncture to CVC insertion), complications (arterial puncture, pneumothorax, hydrothorax, malpositioning), any hemodynamic irregularity (ECG changes), radiographic findings to confirm successful CVC insertion was recorded. Results: Number of successful subclavian venous catheterizations was same in both groups (94% vs. 94%) with no significant difference (p= 1.000). 1st attempt success was more in group A as compared to group B, though statistically this was not significant (p= 0.275). Total time spent on CVC insertion (from 1st skin puncture to catheter insertion) was less than 05 mints in 84% patient in group A and 82% in group B. While more than 05 mints were spent on 16% vs. 18% patients in group A vs. B. This was also not statistically significant (p=0.790). In group A 2/50 (4%) while in group B 1/50 (2%) cases were recorded as malpositioning on post-CVC radiograph. Other complications were not encountered in either group. Conclusion: Lowered shoulder and retracted shoulder positions are equally effective for SVC insertion in terms of success, 1st attempt success, total time spent and number of complications.

Comparison of the Characteristics and Hemodynamic Effects of Infraclavicular Subclavian Central Venous Catheterisation Done under Spontaneous Respiration versus Mechanical Ventilation

Comparison of the Characteristics and Hemodynamic Effects of Infraclavicular Subclavian Central Venous Catheterisation Done under Spontaneous Respiration versus Mechanical Ventilation

Basics of Tunneled Dialysis Catheter Placement for Haemodialysis – Single Centre Experience

/non tunneled dialysis catheters or through arteriovenous fistulas/grafts. The tunneled dialysis catheters act as bridge dialysis devices during maturation period of arteriovenous fistulas/grafts and also serve as the last option for end stage renal disease patients who have exhausted all the other dialysis accesses. The aim and objective is to review the basic key concepts of internal Jugular, External Jugular and Subclavian tunneled venous catheter placement, techniques utilized, complications encountered, issues of suboptimal functioning and their management. Subjects and Methods: This was a prospective observational study done in department of Radio diagnosis, Narayana medical college, Nellore. About 54 cases were performed in our institution from December 2018 to Mar 2020 (including three pediatric patients). The age range of these patients is 10 to 75 years. Results: Out of 54 cases, one case had failed, as the guide wire didn’t pass across the brachiocephalic vein. Venogram revealed high grade stenosis of right brachiocephalic vein. There were major complications in two cases, minor complications in five cases with delayed complications in two cases. Conclusion: Tunneled catheters play a key role in serving as bridging devices during maturation of AVF/AVG or as the last option in chronic kidney disease patients in whom all other options have exhausted. Intervention radiologist should have good experience and an overall knowledge of the issues involved in placement of tunneled dialysis catheters, knowledge about the complications, technical issues of suboptimal functioning, for optimal catheter placement and also for improving catheter function.

Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients.

Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children. Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods. Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively). With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.

Value for money in self-regulated procedural simulation.

In self-regulated procedural simulation, learners practise on many simulators (e.g. paracentesis), self-regulating their choice of simulators, time and goals. Current needs assessments cannot predict the number of simulators needed to plan cost-effective self-regulated simulation. Knowing the ratios of simulators and participants would allow for better-informed purchase decisions to be made. We designed 90-minute sessions of self-regulated procedural simulation for internal medicine residents. In Phase1, 51 participants (8.5 per group) could use 22 simulators (US$69925): ultrasound-guided central (n=6) and peripheral (n=2) venous catheterisation; thoracocentesis (n=2); paracentesis (n=2); lumbar puncture (n=6); and arthrocentesis (n=4). We calculated minimal numbers of simulators based on the time that participants used each simulator in order to design a resource-effective Phase2, with 24 participants (with 12 per group) using 14 simulators (US$48720) to meet their needs. Calculated from time of use (83minutes in total), the optimal ratios of simulators expressed for 10 participants were 9.2: 3.7 for jugular and subclavian venous catheterisation (33minutes); 1.5 for thoracocentesis (13minutes), 1.0 for femoral venous catheterisation (9minutes), 1.0 for lumbar puncture (9minutes), 0.8 for peripheral venous catheterisation (8minutes), 0.7 for paracentesis (6minutes) and 0.5 for arthrocentesis (5minutes). In Phase2, the usage rate of simulators increased from 35.5% to 76.6%, maintaining the total time of use at 80.4minutes. We present a replicable method for the cost-effective planning of self-regulated simulation by measuring the use of simulators. Expressed as ratios of simulators per participant, this information can support purchase decisions and be shared with similar programmes.

Pinch-off syndrome ou syndrome de la Pince Costo-Claviculaire

Implantable catheter systems are the most common procedure used for patients requiring chemotherapy or long-term drug administration. Several procedures are used for the installation of these systems. Patients with long-term subclavian venous catheters described a progressive rupture of the catheter which is a rare complication. This rupture is most often due to costoclavicular forceps or Pinch-off syndrome (POS). We report 07 cases of Pinch-off syndrome to evaluate our diagnostic and therapeutic approach.

The effects of ipsilateral tilt position on right subclavian venous catheterization: study protocol for a prospective randomized trial

BackgroundThe cross-sectional area of the subclavian vein (csSCV) is an important factor determining the success rate of SCV catheterization. The head-down position increases the csSCV. However, the effects of lateral tilting on subclavian venous cross-sectional area have not yet been explored. In this trial, we test our hypothesis that ipsilateral tilt during right SCV catheterization may significantly increase the csSCV by impeding blood flow to the heart, thereby increasing the primary venipuncture success rate and reducing the complication rate and procedure time.Methods/designThis is a two-staged, prospective, randomized, controlled trial conducted on 237 neurosurgical patients requiring SCV catheterization. Seventeen patients in stage I will be placed in supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in random order. The right csSCV will be measured using ultrasonography at each position. In stage II, 220 patients will be randomly assigned to the ipsilateral tilt group (n = 110) and supine group (n = 110) according to the position for right SCV catheterization. Data on catheterization-related characteristics and complications will be collected during and after catheterization. The primary outcome measures are the right csSCV for stage I and primary venipuncture success rate for stage II. The secondary outcome measures for stage II are time to venipuncture, total catheterization time, first-pass success rate, and complications, such as arterial puncture, hematoma, pneumothorax, air embolism, and catheter misplacement.DiscussionThis is the first trial to investigate the effects of the ipsilateral tilt position on right SCV catheterization. We will attest the beneficial effects of the ipsilateral tilt position on the csSCV and the primary venipuncture success rate during right SCV catheterization. Furthermore, comparisons of the first-pass success rate, complications, and total catheterization time during SCV catheterization in the ipsilateral tilt position vs. the supine position will help us determine which position is better for safe and easy SCV catheterization.Trial registrationClinicalTrials.gov, ID: NCT03296735. Registered on 25 September 2017 for stage I; NCT03303274 Registered on 6 October 2017 for stage II.

Placement of tunnelled hemodialysis catheters across stenotic and occluded central veins.

PURPOSE. The purpose of this study was to evaluate the efficacy of placement of tunneled hemodialysis catheters in patients with occluded or stenotic central veins. MATERIALS AND METHODS. Data were prospectively collected for 26 patients (11 male, 15 female, mean age 52 years) referred for placement of tunneled hemodialysis catheters with central venous stenoses or occlusions. The central venous occlusions or stenoses were recanalized using traditional interventional catheter and guidewire techniques.<br />RESULTS. Thirty central venous access procedures were performed of which 28 (93%) procedures resulted in successful tunneled catheter insertion. Twenty-one internal jugular venous (13 right, 8 left) and 7 subclavian venous (3 right, 4 left) catheters were placed. Eighteen stenotic and 10 occluded venous segments were crossed including the brachiocephalic vein (n = 22), subclavian vein (n = 2), and the superior vena cava (4). One patient required insertion of a metallic stent to facilitate passage of the hemodialysis catheter across an occluded brachiocephalic vein. No procedure-related complications occurred. No episodes of upper extremity swelling or superior vena cava syndrome occurred following catheter insertion.<br />CONCLUSIONS. Insertion of tunneled hemodialysis catheter across occluded or stenotic central veins is technically feasible and safe. The use of occluded or stenotic central veins for catheter access preserves patent central veins for future shunt access.

Port catheter complications and thrombosis issues: assessment of 114 patients with port catheter implantation by single surgeon

Background: We provided a comparative presentation of complications seen in 114 patients with port catheter implantation. In addition, we addressed whether patients with catheter-related thrombosis have distinctive features by assessing patients who developed thrombosis either at the catheter implant site or vascular bed.&#x0D; Methods: In this study, we analyzed data from 114 patients who underwent subclavian venous port catheter implantation by a single surgeon at Kayseri Teaching Hospital (Turkey) during 2013 to 2016. Subclavian port catheter was inserted in all cases. The diagnosis of port thrombosis was made by Doppler sonography or thorax CT scan with contrast enhancement in patients presenting with edema at upper extremity, swelling or pain at neck, and/or dysfunctional port.&#x0D; Results: Seroma was detected in only one case, lymphedema developed in one case (0.8%), and pneumothorax was observed in 3 cases. The subclavian vein was implanted on the right side in all patients with pneumothorax. None of these cases were associated with thrombosis. Port infection was observed in one case (0.8%). There was also one case (0.8%) of skin necrosis. The port was removed in 15 patients due to several reasons, which are indicated in Table 2. Thromboembolic events were observed in 11 of the 114 patients while port thrombosis was observed in 7 patients. The rate of hypertension in the thromboembolism group was 61.1% (11/18 individual) while the rate of hypertension in the group without thromboembolism was 28.1% (27/96 individuals); this difference was statistically significant (p = 0.006).&#x0D; Conclusion: In this study, based on complications observed in patients with catheter-related thrombosis, factors such as smoking or diabetes mellitus were seen to be linked to thromboembolism and should be taken into consideration. Moreover, it was observed that hypertension had a significant association with thromboembolism.

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

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.