Comparison between Supraclavicular and Infraclavicular Approach in Subclavian Vein Catheterization in a Tertiaray Center in Nepal

Abstract

Introduction: Central vein catheterization can be introduced in subclavian (SCV), interjugular 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 infraclavicualr (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 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 group. Access time, success rate of cannulation, number of attempts to cannulate vein, ease of guide wire and catheter insertion, length of catheter inserted and associated complications in both group were recorded. 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 out of 35) was better as compared with group IC (33 out of 35) using IC approach. First attempt success 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 landmarks accessibility, success rate and rate of complications.

Keywords

• central venous catheter
• Infracavicular approach
• subclavian vein cannulation
• supraclavicular approach