Author(s): Paul Ovungal Raphael1, Binu Puthur Simon2, Chandan Thankappan3, Lini Chacko4
The Subclavian Vein (SV) is one of the preferred route for central venous catheterisation. There is limited data comparing the efficacy of Ultrasound (US) guided Supraclavicular (SC) and Infraclavicular (IC) approaches for SV cannulation in India. The purpose of this study was to compare the effectiveness of these procedures.
We selected 130 patients aged ≥18 years (Mean age 59, men 57%) and recruited them equally into a supraclavicular and infraclavicular groups on alternate basis. Catheterisation was done by a single experienced anaesthesiologist using standard protocols. Information on age, sex, time for locating the vein, puncture time, number of attempts, catheter insertion time and incidence of complications were collected using a structured proforma. Data were analysed comparing the two groups using SPSS.
The mean time for locating the vein was 24 seconds (s) in the infraclavicular group which is significantly higher than that in the supraclavicular group, 17s (p<0.001). The puncture time was 54 s in the IC group and 40 s in the SC group (p=0.001). Catheterisation time was 132 s in the IC group and 120 s in the SC group (p=0.003). Number of multiple attempts was 22 in the IC group and 8 in the SC group (p=0.005). There were no complications and no guide wire misplacements in either group.
The supraclavicular approach for US-guided subclavian vein catheterisation in adults is clinically more advantageous in terms of shorter time for location, puncture time, catheterisation time, lower number of attempts & a potentially lower incidence of complications when compared to the infraclavicular approach.