Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial

Abstract

Background The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit. Methods A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented. Results The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p < 0.001) and a shorter insertion time (43.98 ± 26.77 vs. 53.12 ± 40.21 s; p = 0.038). In the IP-SCCV group, we recorded a fewer number of puncture attempts (1.16 ± 0.39 vs. 1.47 ± 0.71; p < 0.001), needle redirections (0.69 ± 0.58 vs. 1.17 ± 0.95; p < 0.001), difficulties in guidewire advancement (2.4% vs. 27.4%; p < 0.001), venous collapse (2.4%, vs. 18.4%; p < 0.001) and adverse events (8.8% vs. 13.6%; p = 0.22). Conclusions The IP-SSCV approach is an effective and a safe alternative to the classic OOP-IJV catheterization in critical adult patients. Trial registration: Clinicaltrials.gov, NCT03879954. Registered March 19, 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03879954.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided

“…There is no conflict of opinion among anesthesiologists regarding USG placement of IJV catheterization as many studies have been proved about its success and safety [ 3 , 4 , 17 ]. Our study also showed the same that the success rate is higher in the real-time ultrasound technique, but using ultrasound pre-location technique and anatomical landmark technique has a much lower success rate.…”

Misplacement of a left internal jugular vein puncture into the subclavian vein in a patient undergoing ECMO: a case report

“…If necessary, ultrasound can be called in to assist, which can help identify early ectopic catheters, and adjustments can be made to ensure the catheter tip is in the correct position. 14…”

Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania

“…The ultrasound-guided supraclavicular subclavian vein approach shows promising results, with shorter puncture time 29.8 s, 4% fewer attempts needed, and less guidewire misplacement – 0% in comparison to the ultrasound-guided infraclavicular approach (46.9 s, 22.2%, and 8.9%, respectively) [ 35 ]. Moreover, it has a higher success rate (98.4%), shorter insertion time (43.9 s), fewer needle redirection attempts (0.69), and less guidewire advancing difficulties – 2.4% in comparison to ultrasound-guided jugular vein (96.8%, 53.1 s, 1.17, 27.4%, respectively) [ 36 ]. The ultrasound-guided supraclavicular subclavian vein approach could potentialy be identified as the simplest route to the central vein, but the advantageous antimicrobial pattern and patient comfort still need to be proven.…”