Comparison Between Supraclavicular and Infraclavicular Approach in Subclavian Vein Catheterization in Tertiary Center of Nepal

Abstract

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any.
 Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value < 0.05 was considered significant.
 Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group.
 Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.

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

“…[ 3 , 5 , 7 , 20 , 22 - 30 ] Twelve studies reported haemothorax (NCT04637347),[ 3 , 5 - 7 , 20 - 23 , 27 , 29 , 30 ] ten reported haematomas (NCT04637347),[ 3 , 5 , 6 , 20 , 22 , 23 , 27 - 29 ] and three reported arrhythmias. [ 6 , 20 , 21 ] Two studies reported hydrothorax,[ 22 , 23 ] and two reported cardiac perforation/tamponade. [ 5 , 22 ] Kocum et al .…”

“…In the present study, we included only RCTs and additionally included seven newly published RCTs unlike the previous systematic review (NCT04637347). [ 3 , 5 , 21 , 23 , 29 , 30 ] The sample size was approximately doubled from 1333 cases to 2482 cases. We demonstrated a robust evidence base for the SC approach using the GRADE approach.…”

Success Rate and Complications of the Supraclavicular Approach for Central Venous Access: A Systematic Review

“…Khapung et al has demonstrated a comparison between the SC and IC approaches and the mean access time in group SC catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value=0.002). Furthermore, the first attempt at central venous catheterization was successful in 74.28% of the patients as compared with 57.14% in the IC group [35]. Similarly, Souadka et al exhibited that a long-term central venous access device for cancer chemotherapy can be performed more effectively with the SC approach [33].…”